Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.78 / $82.25 / $140.68	Facility	26	$57.78	$82.25	$140.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $149.41 / $247.93 / $449.70	Professional		$149.41	$247.93	$449.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.89 / $62.14 / $170.50	Professional	26	$46.89	$62.14	$170.50
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $81.52 / $92.70 / $185.50	Professional	52	$81.52	$92.70	$185.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.21 / $201.03 / $315.74	Professional	TC	$103.21	$201.03	$315.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $129.99 / $252.33 / $379.66	Professional		$129.99	$252.33	$379.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.68 / $84.08 / $99.20	Professional	26	$39.68	$84.08	$99.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $75.89 / $93.53 / $184.48	Professional	TC	$75.89	$93.53	$184.48
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $479.84 / $479.84 / $479.84	Facility	26	$479.84	$479.84	$479.84
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $189.88 / $328.32 / $1,609.32	Professional		$189.88	$328.32	$1,609.32
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.22 / $127.14 / $422.55	Professional	26	$70.22	$127.14	$422.55
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $29.04 / $29.04 / $104.52	Professional	52	$29.04	$29.04	$104.52
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $119.66 / $218.92 / $1,384.00	Professional	TC	$119.66	$218.92	$1,384.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $148.56 / $292.93 / $492.45	Professional		$148.56	$292.93	$492.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.74 / $95.56 / $162.81	Professional	26	$51.74	$95.56	$162.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.09 / $205.61 / $351.13	Professional	TC	$95.09	$205.61	$351.13
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $59.04 / $116.89 / $319.91	Facility	26	$59.04	$116.89	$319.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $170.84 / $343.36 / $627.20	Professional		$170.84	$343.36	$627.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.25 / $115.21 / $145.09	Professional	26	$54.25	$115.21	$145.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $126.47 / $232.59 / $491.70	Professional	TC	$126.47	$232.59	$491.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.44 / $149.27 / $312.59	Professional		$29.44	$149.27	$312.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $83.22 / $100.28 / $107.42	Facility	26	$83.22	$100.28	$107.42
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $78.25 / $78.25	Professional		$78.25	$78.25	$78.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $59.86 / $89.28 / $109.88	Professional	26	$59.86	$89.28	$109.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $145.60 / $232.96 / $359.12	Professional	TC	$145.60	$232.96	$359.12
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $68.86 / $68.86 / $69.45	Facility	26	$68.86	$68.86	$69.45
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $212.90 / $322.05 / $391.25	Professional		$212.90	$322.05	$391.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $78.59 / $119.30 / $142.47	Professional	26	$78.59	$119.30	$142.47
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $134.03 / $204.80 / $248.98	Professional	TC	$134.03	$204.80	$248.98
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 $189.88 / $283.02 / $419.84	Professional		$189.88	$283.02	$419.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $70.22 / $105.18 / $144.97	Professional	26	$70.22	$105.18	$144.97
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $119.66 / $177.84 / $271.31	Professional	TC	$119.66	$177.84	$271.31
United Facility/Professional Professional Modifier Low / Median / High Price $136.51 / $242.19 / $438.33	Professional		$136.51	$242.19	$438.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.31 / $62.15 / $155.22	Professional	26	$50.31	$62.15	$155.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.20 / $147.82 / $274.02	Professional	TC	$86.20	$147.82	$274.02
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $152.93 / $152.93 / $152.93	Professional		$152.93	$152.93	$152.93
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $53.21 / $53.21 / $53.21	Professional	26	$53.21	$53.21	$53.21
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $99.72 / $99.72 / $99.72	Professional	TC	$99.72	$99.72	$99.72