Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.82 / $62.77 / $108.45	Facility	26	$41.82	$62.77	$108.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.68 / $119.90 / $446.00	Professional		$82.68	$119.90	$446.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.34 / $45.50 / $125.61	Professional	26	$33.34	$45.50	$125.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.30 / $60.62 / $137.21	Professional	TC	$48.30	$60.62	$137.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $88.32 / $154.44 / $178.60	Professional		$88.32	$154.44	$178.60
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.50 / $60.75 / $70.72	Professional	26	$27.50	$60.75	$70.72
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $49.97 / $49.97 / $93.70	Professional	TC	$49.97	$49.97	$93.70
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $86.18 / $163.47 / $163.47	Facility	26	$86.18	$163.47	$163.47
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $115.50 / $215.29 / $733.58	Professional		$115.50	$215.29	$733.58
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.82 / $91.19 / $297.45	Professional	26	$50.82	$91.19	$297.45
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $68.09 / $124.82 / $436.20	Professional	TC	$68.09	$124.82	$436.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $98.49 / $160.88 / $274.22	Professional		$98.49	$160.88	$274.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.61 / $67.51 / $111.59	Professional	26	$40.61	$67.51	$111.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.94 / $93.87 / $162.88	Professional	TC	$57.94	$93.87	$162.88
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $36.58 / $78.73 / $132.54	Facility	26	$36.58	$78.73	$132.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $87.73 / $179.25 / $234.18	Professional		$87.73	$179.25	$234.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.58 / $78.12 / $98.61	Professional	26	$36.58	$78.12	$98.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.15 / $102.10 / $138.41	Professional	TC	$51.15	$102.10	$138.41
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.75 / $69.49 / $221.26	Professional		$12.75	$69.49	$221.26
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $55.37 / $71.61 / $75.70	Facility	26	$55.37	$71.61	$75.70
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $75.14 / $75.14 / $87.91	Professional		$75.14	$75.14	$87.91
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.80 / $62.70 / $77.97	Professional	26	$44.80	$62.70	$77.97
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $60.90 / $81.51 / $102.23	Professional	TC	$60.90	$81.51	$102.23
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $49.36 / $49.36 / $49.83	Facility	26	$49.36	$49.36	$49.83
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $129.91 / $195.91 / $240.89	Professional		$129.91	$195.91	$240.89
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.75 / $82.33 / $101.23	Professional	26	$55.75	$82.33	$101.23
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.23 / $112.24 / $139.66	Professional	TC	$74.23	$112.24	$139.66
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 $115.50 / $168.95 / $227.57	Professional		$115.50	$168.95	$227.57
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.82 / $71.83 / $97.01	Professional	26	$50.82	$71.83	$97.01
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $64.68 / $97.95 / $131.94	Professional	TC	$64.68	$97.95	$131.94
United Facility/Professional Professional Modifier Low / Median / High Price $88.42 / $97.26 / $233.78	Professional		$88.42	$97.26	$233.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.11 / $40.46 / $98.47	Professional	26	$38.11	$40.46	$98.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.08 / $55.18 / $134.40	Professional	TC	$49.08	$55.18	$134.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $96.54 / $96.54 / $96.54	Professional		$96.54	$96.54	$96.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.97 / $37.97 / $37.97	Professional	26	$37.97	$37.97	$37.97
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $58.56 / $58.56 / $58.56	Professional	TC	$58.56	$58.56	$58.56