Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.54 / $84.07 / $137.72	Facility	26	$53.54	$84.07	$137.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.75 / $247.65 / $512.13	Professional		$140.75	$247.65	$512.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.61 / $61.45 / $153.56	Professional	26	$46.61	$61.45	$153.56
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $762.60 / $762.60 / $762.60	Professional	50	$762.60	$762.60	$762.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.61 / $195.37 / $308.00	Professional	TC	$103.61	$195.37	$308.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $103.06 / $245.77 / $400.00	Professional		$103.06	$245.77	$400.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.58 / $77.40 / $126.54	Professional	26	$36.58	$77.40	$126.54
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $160.28 / $160.82 / $160.82	Professional	TC	$160.28	$160.82	$160.82
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $442.24 / $442.24 / $442.24	Facility	26	$442.24	$442.24	$442.24
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $185.26 / $320.44 / $1,378.78	Professional		$185.26	$320.44	$1,378.78
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.14 / $116.69 / $388.43	Professional	26	$65.14	$116.69	$388.43
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $228.62 / $265.76 / $594.51	Professional	50	$228.62	$265.76	$594.51
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.12 / $219.06 / $1,332.00	Professional	TC	$120.12	$219.06	$1,332.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.97 / $305.72 / $479.71	Professional		$144.97	$305.72	$479.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.19 / $87.31 / $152.79	Professional	26	$47.19	$87.31	$152.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.63 / $211.15 / $357.65	Professional	TC	$95.63	$211.15	$357.65
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $52.65 / $106.57 / $319.91	Facility	26	$52.65	$106.57	$319.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $178.35 / $352.47 / $604.54	Professional		$178.35	$352.47	$604.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.24 / $100.70 / $132.47	Professional	26	$47.24	$100.70	$132.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $138.82 / $251.07 / $471.63	Professional	TC	$138.82	$251.07	$471.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.33 / $149.27 / $312.59	Professional		$29.33	$149.27	$312.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $76.95 / $92.51 / $95.88	Facility	26	$76.95	$92.51	$95.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $67.06 / $91.66 / $104.88	Professional	26	$67.06	$91.66	$104.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $147.72 / $220.09 / $328.32	Professional	TC	$147.72	$220.09	$328.32
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $63.87 / $63.87 / $63.98	Facility	26	$63.87	$63.87	$63.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $206.72 / $313.39 / $381.89	Professional		$206.72	$313.39	$381.89
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.17 / $110.10 / $131.97	Professional	26	$72.17	$110.10	$131.97
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $134.55 / $203.15 / $249.91	Professional	TC	$134.55	$203.15	$249.91
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 $185.26 / $275.42 / $408.55	Professional		$185.26	$275.42	$408.55
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.14 / $96.88 / $131.52	Professional	26	$65.14	$96.88	$131.52
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $120.12 / $178.54 / $275.54	Professional	TC	$120.12	$178.54	$275.54
United Facility/Professional Professional Modifier Low / Median / High Price $133.75 / $229.62 / $424.70	Professional		$133.75	$229.62	$424.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.56 / $54.91 / $139.88	Professional	26	$43.56	$54.91	$139.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.19 / $168.59 / $287.00	Professional	TC	$90.19	$168.59	$287.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $149.56 / $149.56 / $149.56	Professional		$149.56	$149.56	$149.56
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.05 / $49.05 / $49.05	Professional	26	$49.05	$49.05	$49.05
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $100.51 / $100.51 / $100.51	Professional	TC	$100.51	$100.51	$100.51