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 / $257.38	Facility	26	$79.18	$124.31	$257.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $494.18 / $922.39	Professional		$250.00	$494.18	$922.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.27 / $140.00 / $257.38	Professional	26	$76.27	$140.00	$257.38
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $187.90 / $304.49	Professional	52	$125.00	$187.90	$304.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $140.21 / $335.00 / $499.00	Professional	TC	$140.21	$335.00	$499.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $193.61 / $363.21 / $562.83	Professional		$193.61	$363.21	$562.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $55.45 / $117.07 / $135.36	Professional	26	$55.45	$117.07	$135.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $231.86 / $231.86 / $235.14	Professional	TC	$231.86	$231.86	$235.14
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $659.84 / $659.84 / $659.84	Facility	26	$659.84	$659.84	$659.84
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $277.20 / $472.81 / $3,145.84	Professional		$277.20	$472.81	$3,145.84
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.02 / $171.97 / $580.88	Professional	26	$97.02	$171.97	$580.88
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $39.94 / $39.94 / $189.07	Professional	52	$39.94	$39.94	$189.07
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $180.18 / $330.00 / $2,772.01	Professional	TC	$180.18	$330.00	$2,772.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $210.81 / $424.12 / $833.81	Professional		$210.81	$424.12	$833.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.09 / $127.93 / $222.02	Professional	26	$70.09	$127.93	$222.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $139.61 / $294.89 / $630.17	Professional	TC	$139.61	$294.89	$630.17
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 $272.04 / $501.11 / $1,141.60	Professional		$272.04	$501.11	$1,141.60
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 $182.49 / $343.72 / $964.19	Professional	TC	$182.49	$343.72	$964.19
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 $114.87 / $137.85 / $142.71	Facility	26	$114.87	$137.85	$142.71
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $160.34 / $257.83	Professional		$160.34	$160.34	$257.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $84.42 / $125.73 / $155.49	Professional	26	$84.42	$125.73	$155.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $270.18 / $580.50	Professional	TC	$190.55	$270.18	$580.50
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $95.13 / $95.13 / $95.51	Facility	26	$95.13	$95.13	$95.51
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $307.24 / $464.57 / $579.38	Professional		$307.24	$464.57	$579.38
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $107.88 / $163.26 / $195.90	Professional	26	$107.88	$163.26	$195.90
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $198.98 / $300.00 / $382.98	Professional	TC	$198.98	$300.00	$382.98
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 $277.20 / $408.28 / $585.85	Professional		$277.20	$408.28	$585.85
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $97.02 / $144.63 / $194.98	Professional	26	$97.02	$144.63	$194.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $180.18 / $268.32 / $390.87	Professional	TC	$180.18	$268.32	$390.87
United Facility/Professional Professional Modifier Low / Median / High Price $187.74 / $378.22 / $684.53	Professional		$187.74	$378.22	$684.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.73 / $84.40 / $212.22	Professional	26	$64.73	$84.40	$212.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.01 / $253.26 / $480.95	Professional	TC	$123.01	$253.26	$480.95
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $220.13 / $220.13 / $220.13	Professional		$220.13	$220.13	$220.13
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 $146.96 / $146.96 / $146.96	Professional	TC	$146.96	$146.96	$146.96