Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.97 / $66.73 / $109.09	Facility	26	$33.97	$66.73	$109.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.64 / $115.64 / $347.97	Professional		$57.64	$115.64	$347.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $34.51 / $95.57	Professional	26	$24.78	$34.51	$95.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.29 / $78.92 / $205.48	Professional	TC	$18.29	$78.92	$205.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $48.78 / $97.09 / $106.17	Professional		$48.78	$97.09	$106.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $66.86 / $70.80 / $74.05	Professional	26	$66.86	$70.80	$74.05
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $90.29 / $193.75 / $193.75	Facility	26	$90.29	$193.75	$193.75
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $80.39 / $134.19 / $558.63	Professional		$80.39	$134.19	$558.63
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.47 / $95.62 / $354.83	Professional	26	$48.47	$95.62	$354.83
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $80.66 / $92.68 / $191.28	Professional	50	$80.66	$92.68	$191.28
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.75 / $39.27 / $430.88	Professional	TC	$19.75	$39.27	$430.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.33 / $138.79 / $213.12	Professional		$81.33	$138.79	$213.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.21 / $62.41 / $128.44	Professional	26	$33.21	$62.41	$128.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.32 / $40.83 / $150.93	Professional	TC	$18.32	$40.83	$150.93
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $29.45 / $63.85 / $129.37	Facility	26	$29.45	$63.85	$129.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $101.06 / $178.41 / $289.63	Professional		$101.06	$178.41	$289.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.45 / $63.27 / $102.54	Professional	26	$29.45	$63.27	$102.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.38 / $130.52 / $213.78	Professional	TC	$31.38	$130.52	$213.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $16.10 / $79.53 / $166.04	Professional		$16.10	$79.53	$166.04
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $50.73 / $70.34 / $85.76	Facility	26	$50.73	$70.34	$85.76
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $77.84 / $86.49 / $146.80	Professional		$77.84	$86.49	$146.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $36.18 / $54.27 / $84.48	Professional	26	$36.18	$54.27	$84.48
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $19.17 / $114.30 / $164.82	Professional	TC	$19.17	$114.30	$164.82
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $40.32 / $40.32 / $58.50	Facility	26	$40.32	$40.32	$58.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.52 / $126.61 / $163.22	Professional		$83.52	$126.61	$163.22
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.46 / $93.06 / $119.97	Professional	26	$62.46	$93.06	$119.97
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.91 / $25.98 / $73.19	Professional	TC	$17.91	$25.98	$73.19
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 $80.39 / $110.29 / $165.27	Professional		$80.39	$110.29	$165.27
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $41.12 / $81.18 / $109.22	Professional	26	$41.12	$81.18	$109.22
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $20.28 / $25.06 / $76.66	Professional	TC	$20.28	$25.06	$76.66
United Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $113.52 / $187.85	Professional		$64.31	$113.52	$187.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.34 / $43.38 / $121.61	Professional	26	$31.34	$43.38	$121.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $13.18 / $46.92 / $113.34	Professional	TC	$13.18	$46.92	$113.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $57.39 / $57.39 / $57.39	Professional		$57.39	$57.39	$57.39
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.88 / $44.88 / $44.88	Professional	26	$44.88	$44.88	$44.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $12.51 / $12.51 / $12.51	Professional	TC	$12.51	$12.51	$12.51