Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.42 / $82.64 / $171.60	Facility	26	$62.42	$82.64	$171.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.53 / $316.16 / $634.33	Professional		$181.53	$316.16	$634.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.67 / $77.59 / $210.87	Professional	26	$53.67	$77.59	$210.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $137.68 / $245.67 / $440.02	Professional	TC	$137.68	$245.67	$440.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $139.52 / $159.22 / $357.05	Professional		$139.52	$159.22	$357.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.41 / $88.36 / $106.34	Professional	26	$43.41	$88.36	$106.34
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $51.57 / $63.56 / $108.41	Professional	TC	$51.57	$63.56	$108.41
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $518.00 / $518.00 / $518.00	Facility	26	$518.00	$518.00	$518.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $238.85 / $415.44 / $1,890.30	Professional		$238.85	$415.44	$1,890.30
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.31 / $137.38 / $455.48	Professional	26	$75.31	$137.38	$455.48
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $164.50 / $300.39 / $1,576.92	Professional	TC	$164.50	$300.39	$1,576.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.73 / $367.86 / $602.92	Professional		$186.73	$367.86	$602.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.91 / $104.43 / $174.29	Professional	26	$55.91	$104.43	$174.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $129.22 / $266.50 / $454.62	Professional	TC	$129.22	$266.50	$454.62
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $69.30 / $130.41 / $539.79	Facility	26	$69.30	$130.41	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $232.99 / $428.56 / $783.63	Professional		$232.99	$428.56	$783.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $65.17 / $124.64 / $155.84	Professional	26	$65.17	$124.64	$155.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $162.54 / $306.31 / $611.55	Professional	TC	$162.54	$306.31	$611.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.92 / $156.16 / $375.54	Professional		$30.92	$156.16	$375.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $90.14 / $108.28 / $119.26	Facility	26	$90.14	$108.28	$119.26
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $155.88	Professional		$140.29	$140.29	$155.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $70.80 / $101.46 / $122.82	Professional	26	$70.80	$101.46	$122.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $151.60 / $267.89 / $434.24	Professional	TC	$151.60	$267.89	$434.24
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $73.84 / $73.84 / $74.95	Facility	26	$73.84	$73.84	$74.95
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $267.02 / $404.72 / $495.14	Professional		$267.02	$404.72	$495.14
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $85.06 / $128.72 / $153.72	Professional	26	$85.06	$128.72	$153.72
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $275.58 / $341.64	Professional	TC	$181.97	$275.58	$341.64
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $346.39 / $851.78	Facility	26	$346.39	$346.39	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $238.85 / $355.69 / $511.35	Professional		$238.85	$355.69	$511.35
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $75.31 / $113.49 / $156.34	Professional	26	$75.31	$113.49	$156.34
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $163.55 / $242.20 / $348.57	Professional	TC	$163.55	$242.20	$348.57
United Facility/Professional Professional Modifier Low / Median / High Price $169.33 / $290.62 / $537.67	Professional		$169.33	$290.62	$537.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.17 / $67.06 / $167.38	Professional	26	$54.17	$67.06	$167.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.03 / $197.31 / $370.58	Professional	TC	$115.03	$197.31	$370.58
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $193.00 / $193.00 / $193.00	Professional		$193.00	$193.00	$193.00
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $57.48 / $57.48 / $57.48	Professional	26	$57.48	$57.48	$57.48
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $135.51 / $135.51 / $135.51	Professional	TC	$135.51	$135.51	$135.51