Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $32.82 / $55.94 / $137.13	Facility		$32.82	$55.94	$137.13
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.99 / $5.27 / $8.48	Facility	26	$3.99	$5.27	$8.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.72 / $31.91 / $61.75	Professional		$21.72	$31.91	$61.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.84 / $4.23 / $8.46	Professional	26	$2.84	$4.23	$8.46
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $9.31 / $15.02 / $25.02	Professional	52	$9.31	$15.02	$25.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.35 / $28.82 / $47.46	Professional	TC	$18.35	$28.82	$47.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $49.41 / $49.41 / $49.41	Professional		$49.41	$49.41	$49.41
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $68.06 / $132.93 / $219.86	Facility		$68.06	$132.93	$219.86
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $31.42 / $51.28 / $311.26	Professional		$31.42	$51.28	$311.26
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $4.16 / $7.07 / $129.00	Professional	26	$4.16	$7.07	$129.00
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $22.89 / $33.34 / $74.36	Professional	50	$22.89	$33.34	$74.36
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.26 / $45.80 / $252.63	Professional	TC	$27.26	$45.80	$252.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.90 / $45.45 / $76.98	Professional		$23.90	$45.45	$76.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.27 / $6.06 / $10.72	Professional	26	$3.27	$6.06	$10.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.86 / $38.02 / $67.70	Professional	TC	$20.86	$38.02	$67.70
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $25.03 / $53.06 / $156.40	Facility		$25.03	$53.06	$156.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $3.81 / $7.58 / $156.40	Facility	26	$3.81	$7.58	$156.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $20.96 / $45.15 / $82.34	Professional		$20.96	$45.15	$82.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $3.37 / $6.88 / $22.38	Professional	26	$3.37	$6.88	$22.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $17.82 / $38.26 / $62.86	Professional	TC	$17.82	$38.26	$62.86
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.15 / $54.51 / $92.81	Professional		$9.15	$54.51	$92.81
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $33.63 / $45.17 / $57.00	Facility		$33.63	$45.17	$57.00
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $4.94 / $5.76 / $6.84	Facility	26	$4.94	$5.76	$6.84
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $4.22 / $5.81 / $9.72	Professional	26	$4.22	$5.81	$9.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $23.52 / $33.50 / $46.02	Professional	TC	$23.52	$33.50	$46.02
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $30.80 / $30.80 / $31.99	Facility		$30.80	$30.80	$31.99
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $4.08 / $4.08 / $4.11	Facility	26	$4.08	$4.08	$4.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.40 / $53.36 / $65.67	Professional		$35.40	$53.36	$65.67
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $4.62 / $7.06 / $8.57	Professional	26	$4.62	$7.06	$8.57
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.82 / $46.50 / $57.18	Professional	TC	$30.82	$46.50	$57.18
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $89.29 / $120.14 / $220.88	Facility		$89.29	$120.14	$220.88
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $107.98 / $107.98 / $188.60	Facility	26	$107.98	$107.98	$188.60
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $31.42 / $45.53 / $60.13	Professional		$31.42	$45.53	$60.13
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $4.16 / $5.92 / $8.08	Professional	26	$4.16	$5.92	$8.08
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $27.26 / $39.68 / $52.40	Professional	TC	$27.26	$39.68	$52.40
United Facility/Professional Professional Modifier Low / Median / High Price $22.38 / $46.85 / $69.98	Professional		$22.38	$46.85	$69.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $3.46 / $6.68 / $11.21	Professional	26	$3.46	$6.68	$11.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.14 / $37.18 / $56.99	Professional	TC	$20.14	$37.18	$56.99
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $26.71 / $26.71 / $26.71	Professional		$26.71	$26.71	$26.71
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $3.15 / $3.15 / $3.15	Professional	26	$3.15	$3.15	$3.15
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $23.56 / $23.56 / $23.56	Professional	TC	$23.56	$23.56	$23.56