Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.07 / $64.53 / $114.60	Facility	26	$39.07	$64.53	$114.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.70 / $127.74 / $297.99	Professional		$98.70	$127.74	$297.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.67 / $39.07 / $86.60	Professional	26	$32.67	$39.07	$86.60
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $127.73 / $236.31 / $783.34	Professional	50	$127.73	$236.31	$783.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.03 / $81.48 / $192.76	Professional	TC	$66.03	$81.48	$192.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.38 / $80.06 / $231.96	Professional		$72.38	$80.06	$231.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.39 / $60.04 / $100.98	Professional	26	$19.39	$60.04	$100.98
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $108.57 / $147.88 / $347.94	Professional	50	$108.57	$147.88	$347.94
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $72.45 / $85.00 / $157.44	Facility	26	$72.45	$85.00	$157.44
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $143.22 / $257.95 / $884.33	Professional		$143.22	$257.95	$884.33
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.59 / $85.61 / $286.35	Professional	26	$47.59	$85.61	$286.35
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $154.32 / $185.51 / $297.12	Professional	50	$154.32	$185.51	$297.12
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.63 / $169.65 / $597.98	Professional	TC	$95.63	$169.65	$597.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.83 / $191.48 / $331.70	Professional		$115.83	$191.48	$331.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.70 / $63.68 / $106.25	Professional	26	$38.70	$63.68	$106.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.23 / $128.37 / $224.53	Professional	TC	$77.23	$128.37	$224.53
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $34.10 / $73.11 / $123.55	Facility	26	$34.10	$73.11	$123.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $105.71 / $214.83 / $284.36	Professional		$105.71	$214.83	$284.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.10 / $71.83 / $91.57	Professional	26	$34.10	$71.83	$91.57
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $71.95 / $142.29 / $194.07	Professional	TC	$71.95	$142.29	$194.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.43 / $100.63 / $227.98	Professional		$21.43	$100.63	$227.98
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $56.65 / $68.47 / $69.68	Facility	26	$56.65	$68.47	$69.68
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $45.32 / $59.07 / $76.44	Professional	26	$45.32	$59.07	$76.44
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $96.98 / $120.70 / $147.72	Professional	TC	$96.98	$120.70	$147.72
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $46.66 / $46.66 / $47.07	Facility	26	$46.66	$46.66	$47.07
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $160.32 / $236.64 / $288.69	Professional		$160.32	$236.64	$288.69
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.61 / $79.13 / $96.54	Professional	26	$53.61	$79.13	$96.54
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $106.71 / $157.51 / $192.15	Professional	TC	$106.71	$157.51	$192.15
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $143.22 / $205.91 / $276.64	Professional		$143.22	$205.91	$276.64
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $47.59 / $68.86 / $92.51	Professional	26	$47.59	$68.86	$92.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $95.63 / $137.68 / $184.13	Professional	TC	$95.63	$137.68	$184.13
United Facility/Professional Professional Modifier Low / Median / High Price $105.39 / $119.27 / $284.37	Professional		$105.39	$119.27	$284.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.74 / $40.68 / $98.79	Professional	26	$35.74	$40.68	$98.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.61 / $78.80 / $188.73	Professional	TC	$71.61	$78.80	$188.73
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $115.98 / $115.98 / $115.98	Professional		$115.98	$115.98	$115.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $36.39 / $36.39 / $36.39	Professional	26	$36.39	$36.39	$36.39
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $79.59 / $79.59 / $79.59	Professional	TC	$79.59	$79.59	$79.59