Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.21 / $35.11 / $85.68	Facility	26	$26.21	$35.11	$85.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.41 / $86.03 / $311.95	Professional		$53.41	$86.03	$311.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.92 / $26.21 / $85.68	Professional	26	$16.92	$26.21	$85.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.11 / $56.82 / $100.45	Professional	TC	$27.11	$56.82	$100.45
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $39.36 / $73.89 / $103.56	Professional		$39.36	$73.89	$103.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.50 / $37.72 / $42.29	Professional	26	$18.50	$37.72	$42.29
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $22.81 / $22.81 / $62.90	Professional	TC	$22.81	$22.81	$62.90
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $55.69 / $115.00 / $115.00	Facility	26	$55.69	$115.00	$115.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $65.59 / $115.75 / $575.66	Professional		$65.59	$115.75	$575.66
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.88 / $54.20 / $232.81	Professional	26	$31.88	$54.20	$232.81
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.26 / $69.20 / $398.91	Professional	TC	$39.26	$69.20	$398.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.89 / $103.26 / $171.83	Professional		$57.89	$103.26	$171.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.40 / $41.46 / $71.34	Professional	26	$22.40	$41.46	$71.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.19 / $60.38 / $121.16	Professional	TC	$30.19	$60.38	$121.16
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $22.01 / $43.50 / $84.24	Facility	26	$22.01	$43.50	$84.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $70.77 / $117.31 / $221.41	Professional		$70.77	$117.31	$221.41
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.01 / $43.17 / $62.51	Professional	26	$22.01	$43.17	$62.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.61 / $66.88 / $177.24	Professional	TC	$34.61	$66.88	$177.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.62 / $65.14 / $147.70	Professional		$12.62	$65.14	$147.70
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $34.40 / $45.07 / $47.18	Facility	26	$34.40	$45.07	$47.18
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $35.67 / $35.67 / $60.54	Professional		$35.67	$35.67	$60.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $26.68 / $35.85 / $53.25	Professional	26	$26.68	$35.85	$53.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.95 / $48.41 / $117.25	Professional	TC	$30.95	$48.41	$117.25
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $31.26 / $31.26 / $31.53	Facility	26	$31.26	$31.26	$31.53
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.26 / $111.09 / $138.96	Professional		$75.26	$111.09	$138.96
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.96 / $53.26 / $64.67	Professional	26	$35.96	$53.26	$64.67
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.18 / $58.43 / $74.05	Professional	TC	$39.18	$58.43	$74.05
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 $65.59 / $97.28 / $131.05	Professional		$65.59	$97.28	$131.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $31.88 / $46.22 / $61.98	Professional	26	$31.88	$46.22	$61.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.72 / $51.48 / $69.95	Professional	TC	$33.72	$51.48	$69.95
United Facility/Professional Professional Modifier Low / Median / High Price $49.44 / $74.12 / $148.13	Professional		$49.44	$74.12	$148.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.00 / $25.48 / $65.91	Professional	26	$20.00	$25.48	$65.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.18 / $38.68 / $80.06	Professional	TC	$24.18	$38.68	$80.06
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $55.98 / $55.98 / $55.98	Professional		$55.98	$55.98	$55.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $24.52 / $24.52 / $24.52	Professional	26	$24.52	$24.52	$24.52
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $31.45 / $31.45 / $31.45	Professional	TC	$31.45	$31.45	$31.45