Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.18 / $124.31 / $228.28	Facility	26	$79.18	$124.31	$228.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $494.18 / $922.02	Professional		$250.00	$494.18	$922.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.05 / $140.00 / $256.05	Professional	26	$78.05	$140.00	$256.05
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $188.29 / $315.27	Professional	52	$125.00	$188.29	$315.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $142.96 / $335.00 / $499.00	Professional	TC	$142.96	$335.00	$499.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $160.43 / $360.61 / $561.91	Professional		$160.43	$360.61	$561.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.55 / $112.51 / $187.00	Professional	26	$54.55	$112.51	$187.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $230.60 / $230.60 / $270.41	Professional	TC	$230.60	$230.60	$270.41
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 Professional Modifier Low / Median / High Price $276.74 / $471.22 / $2,901.82	Professional		$276.74	$471.22	$2,901.82
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.02 / $174.30 / $577.95	Professional	26	$97.02	$174.30	$577.95
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $39.94 / $39.94 / $188.68	Professional	52	$39.94	$39.94	$188.68
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $179.72 / $329.08 / $2,498.98	Professional	TC	$179.72	$329.08	$2,498.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $210.08 / $423.71 / $794.94	Professional		$210.08	$423.71	$794.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.13 / $128.22 / $223.39	Professional	26	$70.13	$128.22	$223.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $139.24 / $294.89 / $620.41	Professional	TC	$139.24	$294.89	$620.41
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $78.05 / $159.18 / $698.97	Facility	26	$78.05	$159.18	$698.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $272.04 / $501.11 / $1,147.40	Professional		$272.04	$501.11	$1,147.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $70.37 / $153.69 / $194.07	Professional	26	$70.37	$153.69	$194.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $182.49 / $343.72 / $937.81	Professional	TC	$182.49	$343.72	$937.81
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 $114.40 / $137.85 / $142.04	Facility	26	$114.40	$137.85	$142.04
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 $85.01 / $135.68 / $157.91	Professional	26	$85.01	$135.68	$157.91
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $191.88 / $282.74 / $674.37	Professional	TC	$191.88	$282.74	$674.37
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $95.06 / $95.06 / $95.13	Facility	26	$95.06	$95.06	$95.13
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $306.20 / $462.99 / $578.45	Professional		$306.20	$462.99	$578.45
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $108.26 / $163.26 / $194.96	Professional	26	$108.26	$163.26	$194.96
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $197.95 / $299.20 / $381.98	Professional	TC	$197.95	$299.20	$381.98
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 $276.74 / $406.90 / $585.85	Professional		$276.74	$406.90	$585.85
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $97.02 / $143.94 / $194.98	Professional	26	$97.02	$143.94	$194.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $179.72 / $267.63 / $390.87	Professional	TC	$179.72	$267.63	$390.87
United Facility/Professional Professional Modifier Low / Median / High Price $187.43 / $384.94 / $627.10	Professional		$187.43	$384.94	$627.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.73 / $86.51 / $213.04	Professional	26	$64.73	$86.51	$213.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $122.70 / $258.39 / $441.04	Professional	TC	$122.70	$258.39	$441.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $219.34 / $219.34 / $219.34	Professional		$219.34	$219.34	$219.34
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $73.17 / $73.17 / $73.17	Professional	26	$73.17	$73.17	$73.17
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $146.16 / $146.16 / $146.16	Professional	TC	$146.16	$146.16	$146.16