Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.37 / $44.47 / $81.59	Facility	26	$23.37	$44.47	$81.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.16 / $78.34 / $150.76	Professional		$42.16	$78.34	$150.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.38 / $27.42 / $55.66	Professional	26	$23.38	$27.42	$55.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.32 / $47.17 / $95.08	Professional	TC	$17.32	$47.17	$95.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.29 / $36.29 / $36.29	Professional		$36.29	$36.29	$36.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.05 / $23.59 / $47.36	Professional	26	$20.05	$23.59	$47.36
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $31.71 / $120.92 / $246.13	Facility	26	$31.71	$120.92	$246.13
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $53.93 / $90.24 / $441.00	Professional		$53.93	$90.24	$441.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.34 / $54.60 / $338.48	Professional	26	$32.34	$54.60	$338.48
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.09 / $35.72 / $338.48	Professional	TC	$22.09	$35.72	$338.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.15 / $94.74 / $136.09	Professional		$62.15	$94.74	$136.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.25 / $48.17 / $75.79	Professional	26	$29.25	$48.17	$75.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.97 / $45.08 / $69.51	Professional	TC	$27.97	$45.08	$69.51
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $24.49 / $53.81 / $399.23	Facility	26	$24.49	$53.81	$399.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.08 / $102.85 / $167.68	Professional		$58.08	$102.85	$167.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.49 / $52.04 / $64.56	Professional	26	$24.49	$52.04	$64.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.35 / $56.88 / $107.93	Professional	TC	$33.35	$56.88	$107.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.00 / $52.86 / $89.98	Professional		$9.00	$52.86	$89.98
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.19 / $46.23 / $49.13	Facility	26	$38.19	$46.23	$49.13
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $43.25 / $43.25 / $43.25	Professional		$43.25	$43.25	$43.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $42.33 / $52.26	Professional	26	$31.76	$42.33	$52.26
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $29.67 / $70.73 / $102.84	Professional	TC	$29.67	$70.73	$102.84
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $31.71 / $31.71 / $32.45	Facility	26	$31.71	$31.71	$32.45
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.77 / $89.80 / $110.60	Professional		$58.77	$89.80	$110.60
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.60 / $54.16 / $64.66	Professional	26	$36.60	$54.16	$64.66
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.17 / $33.86 / $44.74	Professional	TC	$22.17	$33.86	$44.74
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $246.13 / $246.13 / $422.45	Facility	26	$246.13	$246.13	$422.45
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $52.21 / $80.68 / $110.73	Professional		$52.21	$80.68	$110.73
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $32.34 / $48.85 / $63.77	Professional	26	$32.34	$48.85	$63.77
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $19.87 / $31.38 / $45.63	Professional	TC	$19.87	$31.38	$45.63
United Facility/Professional Professional Modifier Low / Median / High Price $50.38 / $78.44 / $109.88	Professional		$50.38	$78.44	$109.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.36 / $33.19 / $61.50	Professional	26	$28.36	$33.19	$61.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.13 / $34.51 / $65.37	Professional	TC	$28.13	$34.51	$65.37
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $45.61 / $45.61 / $45.61	Professional		$45.61	$45.61	$45.61
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $25.60 / $25.60 / $25.60	Professional	26	$25.60	$25.60	$25.60
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $20.01 / $20.01 / $20.01	Professional	TC	$20.01	$20.01	$20.01