Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.83 / $28.42 / $72.89	Facility	26	$25.83	$28.42	$72.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.64 / $66.92 / $181.60	Professional		$28.64	$66.92	$181.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.17 / $32.74 / $97.80	Professional	26	$17.17	$32.74	$97.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $9.18 / $26.50 / $68.73	Professional	TC	$9.18	$26.50	$68.73
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $63.81 / $118.05 / $132.50	Professional		$63.81	$118.05	$132.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.14 / $54.80 / $63.36	Professional	26	$26.14	$54.80	$63.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $58.98 / $58.98 / $69.13	Professional	TC	$58.98	$58.98	$69.13
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $77.38 / $148.36 / $148.36	Facility	26	$77.38	$148.36	$148.36
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $65.58 / $134.54 / $541.79	Professional		$65.58	$134.54	$541.79
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.10 / $73.20 / $269.85	Professional	26	$35.10	$73.20	$269.85
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $51.46 / $89.93 / $100.94	Professional	50	$51.46	$89.93	$100.94
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.54 / $66.50 / $271.95	Professional	TC	$18.54	$66.50	$271.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.06 / $90.95 / $193.01	Professional		$40.06	$90.95	$193.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.29 / $47.66 / $97.09	Professional	26	$25.29	$47.66	$97.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.35 / $44.28 / $95.92	Professional	TC	$13.35	$44.28	$95.92
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $22.94 / $48.51 / $98.43	Facility	26	$22.94	$48.51	$98.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $42.24 / $86.12 / $142.62	Professional		$42.24	$86.12	$142.62
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.94 / $46.99 / $78.02	Professional	26	$22.94	$46.99	$78.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $13.85 / $29.45 / $83.64	Professional	TC	$13.85	$29.45	$83.64
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 $38.76 / $53.35 / $64.98	Facility	26	$38.76	$53.35	$64.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.14 / $42.08 / $63.92	Professional	26	$28.14	$42.08	$63.92
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $14.10 / $21.42 / $62.31	Professional	TC	$14.10	$21.42	$62.31
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $30.80 / $30.80 / $44.33	Facility	26	$30.80	$30.80	$44.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.09 / $114.21 / $172.35	Professional		$79.09	$114.21	$172.35
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.40 / $70.52 / $90.92	Professional	26	$46.40	$70.52	$90.92
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.87 / $55.51 / $87.17	Professional	TC	$19.87	$55.51	$87.17
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 $77.15 / $116.76 / $163.21	Professional		$77.15	$116.76	$163.21
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $31.42 / $62.02 / $82.77	Professional	26	$31.42	$62.02	$82.77
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $18.54 / $60.50 / $83.53	Professional	TC	$18.54	$60.50	$83.53
United Facility/Professional Professional Modifier Low / Median / High Price $35.38 / $58.10 / $140.35	Professional		$35.38	$58.10	$140.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.82 / $30.68 / $89.35	Professional	26	$23.82	$30.68	$89.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.82 / $33.20 / $61.10	Professional	TC	$10.82	$33.20	$61.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $71.62 / $71.62 / $71.62	Professional		$71.62	$71.62	$71.62
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $34.25 / $34.25 / $34.25	Professional	26	$34.25	$34.25	$34.25
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $37.36 / $37.36 / $37.36	Professional	TC	$37.36	$37.36	$37.36