Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.75 / $123.63 / $255.22	Facility	26	$78.75	$123.63	$255.22
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $51.81 / $108.26 / $261.82	Facility	53	$51.81	$108.26	$261.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $475.00 / $971.50	Professional		$250.00	$475.00	$971.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.00 / $140.00 / $289.50	Professional	26	$74.00	$140.00	$289.50
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $187.50 / $310.92	Professional	52	$125.00	$187.50	$310.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $180.31 / $335.00 / $499.00	Professional	TC	$180.31	$335.00	$499.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $156.31 / $373.64 / $574.48	Professional		$156.31	$373.64	$574.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $55.19 / $111.97 / $135.72	Professional	26	$55.19	$111.97	$135.72
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $242.42 / $242.42 / $284.29	Professional	TC	$242.42	$242.42	$284.29
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $656.72 / $656.72 / $656.72	Facility	26	$656.72	$656.72	$656.72
Asuris Northwest Health Facility/Professional Facility Modifier 53 Low / Median / High Price $84.87 / $285.58 / $285.58	Facility	53	$84.87	$285.58	$285.58
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $283.20 / $484.71 / $2,872.81	Professional		$283.20	$484.71	$2,872.81
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $96.56 / $168.42 / $584.49	Professional	26	$96.56	$168.42	$584.49
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $39.72 / $42.91 / $195.12	Professional	52	$39.72	$42.91	$195.12
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.65 / $341.02 / $2,498.98	Professional	TC	$186.65	$341.02	$2,498.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $216.32 / $433.62 / $817.92	Professional		$216.32	$433.62	$817.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.83 / $127.30 / $220.92	Professional	26	$69.83	$127.30	$220.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $145.49 / $299.26 / $704.13	Professional	TC	$145.49	$299.26	$704.13
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $78.05 / $158.80 / $698.97	Facility	26	$78.05	$158.80	$698.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $279.67 / $515.92 / $1,254.40	Professional		$279.67	$515.92	$1,254.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.13 / $149.29 / $192.93	Professional	26	$69.13	$149.29	$192.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $190.13 / $357.84 / $1,085.66	Professional	TC	$190.13	$357.84	$1,085.66
Molina Facility/Professional Professional Modifier Low / Median / High Price $37.16 / $177.58 / $385.40	Professional		$37.16	$177.58	$385.40
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $114.32 / $137.19 / $141.37	Facility	26	$114.32	$137.19	$141.37
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $160.34 / $160.34	Professional		$160.34	$160.34	$160.34
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $95.44 / $126.60 / $148.76	Professional	26	$95.44	$126.60	$148.76
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $193.36 / $283.79 / $759.50	Professional	TC	$193.36	$283.79	$759.50
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $94.68 / $94.68 / $95.06	Facility	26	$94.68	$94.68	$95.06
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $314.97 / $476.38 / $591.54	Professional		$314.97	$476.38	$591.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $107.88 / $162.47 / $198.02	Professional	26	$107.88	$162.47	$198.02
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $206.72 / $312.60 / $397.80	Professional	TC	$206.72	$312.60	$397.80
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $782.93	Facility	26	$446.45	$446.45	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $283.20 / $418.66 / $602.40	Professional		$283.20	$418.66	$602.40
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $96.56 / $143.94 / $194.98	Professional	26	$96.56	$143.94	$194.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $186.65 / $277.95 / $407.43	Professional	TC	$186.65	$277.95	$407.43
United Facility/Professional Professional Modifier Low / Median / High Price $192.64 / $385.29 / $701.74	Professional		$192.64	$385.29	$701.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.22 / $81.18 / $205.53	Professional	26	$64.22	$81.18	$205.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $127.91 / $263.36 / $478.04	Professional	TC	$127.91	$263.36	$478.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $226.45 / $226.45 / $226.45	Professional		$226.45	$226.45	$226.45
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $72.78 / $72.78 / $72.78	Professional	26	$72.78	$72.78	$72.78
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $153.66 / $153.66 / $153.66	Professional	TC	$153.66	$153.66	$153.66