Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.15 / $139.58 / $677.76	Facility		$48.15	$139.58	$677.76
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.00 / $25.67 / $49.20	Facility	26	$15.00	$25.67	$49.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.91 / $45.61 / $86.67	Professional		$30.91	$45.61	$86.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.00 / $16.26 / $52.35	Professional	26	$13.00	$16.26	$52.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $29.98 / $53.33	Professional	TC	$17.89	$29.98	$53.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $71.31 / $80.12 / $80.12	Professional		$71.31	$80.12	$80.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $22.82 / $25.96	Professional	26	$16.60	$22.82	$25.96
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $78.84 / $123.22 / $514.16	Facility		$78.84	$123.22	$514.16
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $18.73 / $100.00 / $100.00	Facility	26	$18.73	$100.00	$100.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $54.05 / $97.94 / $332.10	Professional		$54.05	$97.94	$332.10
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.29 / $35.15 / $204.67	Professional	26	$19.29	$35.15	$204.67
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.82 / $57.46 / $230.00	Professional	TC	$33.82	$57.46	$230.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.18 / $70.53 / $122.68	Professional		$37.18	$70.53	$122.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $25.88 / $41.20	Professional	26	$16.22	$25.88	$41.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.08 / $44.19 / $81.06	Professional	TC	$21.08	$44.19	$81.06
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $33.17 / $64.52 / $95.98	Facility		$33.17	$64.52	$95.98
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.45 / $28.82 / $37.84	Facility	26	$13.45	$28.82	$37.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $33.17 / $65.48 / $97.37	Professional		$33.17	$65.48	$97.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.76 / $28.87 / $37.92	Professional	26	$13.76	$28.87	$37.92
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.14 / $37.49 / $64.93	Professional	TC	$20.14	$37.49	$64.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $8.97 / $53.82 / $91.70	Professional		$8.97	$53.82	$91.70
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $46.35 / $69.01 / $77.05	Facility		$46.35	$69.01	$77.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $21.98 / $26.25 / $28.81	Facility	26	$21.98	$26.25	$28.81
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.29 / $24.51 / $29.93	Professional	26	$17.29	$24.51	$29.93
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.51 / $33.50 / $42.78	Professional	TC	$22.51	$33.50	$42.78
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $52.56 / $52.56 / $53.00	Facility		$52.56	$52.56	$53.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $18.12 / $18.12 / $18.73	Facility	26	$18.12	$18.12	$18.73
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.85 / $89.79 / $107.79	Professional		$57.85	$89.79	$107.79
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.65 / $31.96 / $38.43	Professional	26	$21.65	$31.96	$38.43
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $37.38 / $57.83 / $69.36	Professional	TC	$37.38	$57.83	$69.36
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $35.57 / $35.57 / $35.57	Facility		$35.57	$35.57	$35.57
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $54.05 / $75.59 / $101.83	Professional		$54.05	$75.59	$101.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.48 / $27.48 / $36.31	Professional	26	$18.48	$27.48	$36.31
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $35.57 / $48.65 / $65.53	Professional	TC	$35.57	$48.65	$65.53
United Facility/Professional Professional Modifier Low / Median / High Price $36.40 / $39.99 / $102.22	Professional		$36.40	$39.99	$102.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.70 / $16.20 / $39.89	Professional	26	$14.70	$16.20	$39.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.92 / $24.61 / $69.30	Professional	TC	$20.92	$24.61	$69.30
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $43.31 / $43.31 / $43.31	Professional		$43.31	$43.31	$43.31
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.83 / $13.83 / $13.83	Professional	26	$13.83	$13.83	$13.83
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $29.48 / $29.48 / $29.48	Professional	TC	$29.48	$29.48	$29.48