Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.25 / $38.29 / $50.00	Facility	26	$28.25	$38.29	$50.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.56 / $38.97 / $93.22	Professional		$31.56	$38.97	$93.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.57 / $25.76 / $58.19	Professional	26	$20.57	$25.76	$58.19
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.00 / $17.98 / $29.64	Professional	52	$15.00	$17.98	$29.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.55 / $13.03 / $24.68	Professional	TC	$10.55	$13.03	$24.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $46.93 / $62.73 / $69.45	Professional		$46.93	$62.73	$69.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.06 / $26.06 / $33.92	Professional	26	$26.06	$26.06	$33.92
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $8.08 / $8.08 / $8.08	Professional	52	$8.08	$8.08	$8.08
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $44.22 / $88.68 / $98.42	Facility	26	$44.22	$88.68	$98.42
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $39.97 / $71.58 / $288.52	Professional		$39.97	$71.58	$288.52
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.59 / $47.52 / $179.55	Professional	26	$26.59	$47.52	$179.55
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $14.69 / $25.36 / $108.90	Professional	TC	$14.69	$25.36	$108.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.92 / $58.10 / $104.44	Professional		$34.92	$58.10	$104.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.34 / $38.53 / $65.95	Professional	26	$23.34	$38.53	$65.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.01 / $19.66 / $38.47	Professional	TC	$12.01	$19.66	$38.47
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $21.08 / $34.47 / $60.97	Facility	26	$21.08	$34.47	$60.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $30.36 / $50.44 / $85.40	Professional		$30.36	$50.44	$85.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.32 / $33.15 / $55.73	Professional	26	$20.32	$33.15	$55.73
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $10.24 / $17.00 / $29.64	Professional	TC	$10.24	$17.00	$29.64
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.69 / $54.33 / $98.65	Professional		$9.69	$54.33	$98.65
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.72 / $42.93 / $43.55	Facility	26	$35.72	$42.93	$43.55
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $25.14 / $35.75 / $43.55	Professional	26	$25.14	$35.75	$43.55
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $13.27 / $24.75 / $24.79	Professional	TC	$13.27	$24.75	$24.79
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $29.45 / $29.45 / $29.71	Facility	26	$29.45	$29.45	$29.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.62 / $76.09 / $92.52	Professional		$47.62	$76.09	$92.52
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.78 / $49.46 / $59.20	Professional	26	$30.78	$49.46	$59.20
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.91 / $26.20 / $33.56	Professional	TC	$16.91	$26.20	$33.56
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $217.18 / $217.18 / $354.01	Facility	26	$217.18	$217.18	$354.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $45.28 / $64.29 / $84.39	Professional		$45.28	$64.29	$84.39
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $30.03 / $42.25 / $55.46	Professional	26	$30.03	$42.25	$55.46
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $15.25 / $21.99 / $29.05	Professional	TC	$15.25	$21.99	$29.05
United Facility/Professional Professional Modifier Low / Median / High Price $34.99 / $53.21 / $92.64	Professional		$34.99	$53.21	$92.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.28 / $35.75 / $62.60	Professional	26	$23.28	$35.75	$62.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.47 / $17.41 / $30.67	Professional	TC	$11.47	$17.41	$30.67
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $28.44 / $37.54 / $37.54	Professional		$28.44	$37.54	$37.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $17.95 / $22.67 / $22.67	Professional	26	$17.95	$22.67	$22.67
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $10.49 / $14.88 / $14.88	Professional	TC	$10.49	$14.88	$14.88