Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.01 / $128.38 / $228.02	Facility	26	$78.01	$128.38	$228.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $311.87 / $494.18 / $963.49	Professional		$311.87	$494.18	$963.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.01 / $140.00 / $252.87	Professional	26	$78.01	$140.00	$252.87
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.82 / $200.00 / $366.68	Professional	52	$125.82	$200.00	$366.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $225.56 / $335.00 / $616.91	Professional	TC	$225.56	$335.00	$616.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $181.10 / $432.38 / $800.00	Professional		$181.10	$432.38	$800.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.76 / $115.36 / $133.38	Professional	26	$53.76	$115.36	$133.38
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $650.32 / $650.32	Facility	26	$446.45	$650.32	$650.32
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $335.41 / $595.83 / $3,507.01	Professional		$335.41	$595.83	$3,507.01
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.63 / $169.48 / $572.63	Professional	26	$95.63	$169.48	$572.63
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $39.35 / $39.35 / $235.52	Professional	52	$39.35	$39.35	$235.52
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $246.28 / $455.57 / $2,477.29	Professional	TC	$246.28	$455.57	$2,477.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $258.33 / $552.85 / $901.41	Professional		$258.33	$552.85	$901.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.08 / $125.57 / $218.80	Professional	26	$69.08	$125.57	$218.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.44 / $421.72 / $707.80	Professional	TC	$186.44	$421.72	$707.80
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $85.28 / $156.90 / $698.97	Facility	26	$85.28	$156.90	$698.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $350.14 / $636.59 / $1,242.05	Professional		$350.14	$636.59	$1,242.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.58 / $153.15 / $190.36	Professional	26	$76.58	$153.15	$190.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $295.38 / $515.52 / $1,075.79	Professional	TC	$295.38	$515.52	$1,075.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $45.08 / $197.99 / $468.56	Professional		$45.08	$197.99	$468.56
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $113.22 / $135.85 / $140.03	Facility	26	$113.22	$135.85	$140.03
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 $84.02 / $119.70 / $145.71	Professional	26	$84.02	$119.70	$145.71
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $292.68 / $440.80 / $652.00	Professional	TC	$292.68	$440.80	$652.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $93.77 / $93.77 / $94.14	Facility	26	$93.77	$93.77	$94.14
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $369.61 / $564.78 / $707.62	Professional		$369.61	$564.78	$707.62
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $106.34 / $160.90 / $193.08	Professional	26	$106.34	$160.90	$193.08
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $262.91 / $401.73 / $515.74	Professional	TC	$262.91	$401.73	$515.74
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 $335.41 / $489.24 / $732.32	Professional		$335.41	$489.24	$732.32
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.63 / $142.55 / $191.30	Professional	26	$95.63	$142.55	$191.30
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $239.78 / $346.85 / $535.07	Professional	TC	$239.78	$346.85	$535.07
United Facility/Professional Professional Modifier Low / Median / High Price $229.76 / $459.53 / $755.71	Professional		$229.76	$459.53	$755.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.81 / $87.90 / $237.76	Professional	26	$63.81	$87.90	$237.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.95 / $341.67 / $585.73	Professional	TC	$165.95	$341.67	$585.73
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $264.44 / $264.44 / $264.44	Professional		$264.44	$264.44	$264.44
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $72.09 / $72.09 / $72.09	Professional	26	$72.09	$72.09	$72.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $192.34 / $192.34 / $192.34	Professional	TC	$192.34	$192.34	$192.34