Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.61 / $71.62 / $113.79	Facility	26	$45.61	$71.62	$113.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $156.83 / $265.06 / $555.66	Professional		$156.83	$265.06	$555.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.93 / $62.08 / $145.44	Professional	26	$41.93	$62.08	$145.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $72.31 / $88.78 / $185.50	Professional	52	$72.31	$88.78	$185.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $107.69 / $201.03 / $308.42	Professional	TC	$107.69	$201.03	$308.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $101.76 / $244.93 / $274.61	Professional		$101.76	$244.93	$274.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.57 / $65.16 / $78.45	Professional	26	$33.57	$65.16	$78.45
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $400.00 / $400.00 / $400.00	Professional	52	$400.00	$400.00	$400.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $167.28 / $167.28 / $196.17	Professional	TC	$167.28	$167.28	$196.17
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $379.28 / $379.28 / $379.28	Facility	26	$379.28	$379.28	$379.28
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $182.95 / $330.74 / $1,413.47	Professional		$182.95	$330.74	$1,413.47
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.44 / $98.76 / $333.52	Professional	26	$55.44	$98.76	$333.52
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $127.51 / $230.88 / $1,220.00	Professional	TC	$127.51	$230.88	$1,220.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.31 / $282.92 / $482.97	Professional		$138.31	$282.92	$482.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.96 / $77.42 / $132.30	Professional	26	$40.96	$77.42	$132.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.89 / $198.33 / $344.33	Professional	TC	$95.89	$198.33	$344.33
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $50.82 / $99.79 / $319.91	Facility	26	$50.82	$99.79	$319.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $157.08 / $325.95 / $618.97	Professional		$157.08	$325.95	$618.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.22 / $91.71 / $137.66	Professional	26	$50.22	$91.71	$137.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $116.71 / $234.63 / $488.92	Professional	TC	$116.71	$234.63	$488.92
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.15 / $149.27 / $312.59	Professional		$29.15	$149.27	$312.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.00 / $79.81 / $97.61	Facility	26	$66.00	$79.81	$97.61
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $91.43 / $91.43 / $91.43	Professional		$91.43	$91.43	$91.43
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $48.80 / $79.81 / $102.06	Professional	26	$48.80	$79.81	$102.06
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $108.80 / $183.78 / $341.88	Professional	TC	$108.80	$183.78	$341.88
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $54.36 / $54.36 / $54.84	Facility	26	$54.36	$54.36	$54.84
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $205.17 / $310.24 / $377.21	Professional		$205.17	$310.24	$377.21
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.16 / $94.25 / $114.24	Professional	26	$62.16	$94.25	$114.24
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $142.79 / $215.75 / $264.89	Professional	TC	$142.79	$215.75	$264.89
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 $182.95 / $272.64 / $372.91	Professional		$182.95	$272.64	$372.91
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $55.44 / $83.04 / $112.89	Professional	26	$55.44	$83.04	$112.89
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $127.51 / $189.61 / $259.91	Professional	TC	$127.51	$189.61	$259.91
United Facility/Professional Professional Modifier Low / Median / High Price $120.25 / $238.51 / $457.11	Professional		$120.25	$238.51	$457.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.43 / $56.90 / $116.68	Professional	26	$37.43	$56.90	$116.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.82 / $169.24 / $281.02	Professional	TC	$82.82	$169.24	$281.02
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $148.44 / $148.44 / $148.44	Professional		$148.44	$148.44	$148.44
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $42.41 / $42.41 / $42.41	Professional	26	$42.41	$42.41	$42.41
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $106.04 / $106.04 / $106.04	Professional	TC	$106.04	$106.04	$106.04