Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.05 / $43.92 / $89.19	Facility	26	$27.05	$43.92	$89.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.75 / $72.30 / $261.00	Professional		$41.75	$72.30	$261.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.37 / $30.05 / $124.43	Professional	26	$21.37	$30.05	$124.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.39 / $27.47 / $60.62	Professional	TC	$20.39	$27.47	$60.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $43.72 / $79.13 / $92.10	Professional		$43.72	$79.13	$92.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.81 / $36.83 / $42.44	Professional	26	$12.81	$36.83	$42.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $17.66 / $17.66 / $38.96	Professional	TC	$17.66	$17.66	$38.96
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $55.98 / $105.96 / $105.96	Facility	26	$55.98	$105.96	$105.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $62.37 / $114.34 / $495.56	Professional		$62.37	$114.34	$495.56
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.79 / $58.75 / $192.38	Professional	26	$32.79	$58.75	$192.38
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.57 / $53.61 / $367.63	Professional	TC	$29.57	$53.61	$367.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.61 / $86.43 / $142.41	Professional		$51.61	$86.43	$142.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.19 / $44.00 / $72.28	Professional	26	$26.19	$44.00	$72.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.52 / $41.77 / $71.41	Professional	TC	$24.52	$41.77	$71.41
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $23.87 / $51.31 / $86.49	Facility	26	$23.87	$51.31	$86.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $46.50 / $92.13 / $131.63	Professional		$46.50	$92.13	$131.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.87 / $50.91 / $64.27	Professional	26	$23.87	$50.91	$64.27
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.72 / $42.75 / $71.75	Professional	TC	$21.72	$42.75	$71.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.62 / $65.14 / $147.48	Professional		$12.62	$65.14	$147.48
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.49 / $46.48 / $48.96	Facility	26	$38.49	$46.48	$48.96
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $22.39 / $22.39	Professional		$22.39	$22.39	$22.39
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $31.63 / $41.76 / $51.28	Professional	26	$31.63	$41.76	$51.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.60 / $37.93 / $45.12	Professional	TC	$25.60	$37.93	$45.12
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $31.99 / $31.99 / $32.15	Facility	26	$31.99	$31.99	$32.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.08 / $102.15 / $125.60	Professional		$69.08	$102.15	$125.60
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.13 / $53.36 / $65.61	Professional	26	$36.13	$53.36	$65.61
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.99 / $48.79 / $59.99	Professional	TC	$32.99	$48.79	$59.99
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 $62.37 / $88.72 / $120.36	Professional		$62.37	$88.72	$120.36
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $32.79 / $46.56 / $62.87	Professional	26	$32.79	$46.56	$62.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $29.57 / $42.57 / $57.48	Professional	TC	$29.57	$42.57	$57.48
United Facility/Professional Professional Modifier Low / Median / High Price $47.64 / $54.82 / $127.30	Professional		$47.64	$54.82	$127.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.89 / $26.80 / $63.82	Professional	26	$24.89	$26.80	$63.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.84 / $24.40 / $60.80	Professional	TC	$21.84	$24.40	$60.80
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $48.99 / $48.99 / $48.99	Professional		$48.99	$48.99	$48.99
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $24.64 / $24.64 / $24.64	Professional	26	$24.64	$24.64	$24.64
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $24.35 / $24.35 / $24.35	Professional	TC	$24.35	$24.35	$24.35