Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.92 / $35.86 / $90.06	Facility	26	$30.92	$35.86	$90.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.16 / $91.98 / $256.08	Professional		$60.16	$91.98	$256.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.46 / $32.75 / $97.65	Professional	26	$23.46	$32.75	$97.65
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $28.62 / $44.08 / $228.44	Professional	52	$28.62	$44.08	$228.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.32 / $63.28 / $160.69	Professional	TC	$33.32	$63.28	$160.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $45.77 / $115.20 / $177.38	Professional		$45.77	$115.20	$177.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.64 / $37.01 / $48.82	Professional	26	$11.64	$37.01	$48.82
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $11.44 / $57.96 / $107.71	Professional	52	$11.44	$57.96	$107.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $49.94 / $49.94 / $49.94	Professional	TC	$49.94	$49.94	$49.94
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $64.51 / $122.62 / $122.62	Facility	26	$64.51	$122.62	$122.62
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $80.44 / $153.59 / $487.80	Professional		$80.44	$153.59	$487.80
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.88 / $64.91 / $265.83	Professional	26	$37.88	$64.91	$265.83
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $15.42 / $15.42 / $35.69	Professional	52	$15.42	$15.42	$35.69
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.43 / $80.58 / $398.99	Professional	TC	$44.43	$80.58	$398.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.95 / $126.92 / $195.30	Professional		$82.95	$126.92	$195.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.00 / $48.70 / $81.05	Professional	26	$29.00	$48.70	$81.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.73 / $79.83 / $116.59	Professional	TC	$46.73	$79.83	$116.59
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $25.11 / $55.05 / $90.98	Facility	26	$25.11	$55.05	$90.98
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $86.67 / $163.16 / $223.79	Professional		$86.67	$163.16	$223.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.11 / $53.70 / $70.31	Professional	26	$25.11	$53.70	$70.31
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $58.28 / $110.49 / $157.60	Professional	TC	$58.28	$110.49	$157.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.62 / $65.14 / $147.48	Professional		$12.62	$65.14	$147.48
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.89 / $52.02 / $54.94	Facility	26	$43.89	$52.02	$54.94
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $92.43 / $92.43 / $92.43	Professional		$92.43	$92.43	$92.43
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.34 / $46.04 / $55.27	Professional	26	$32.34	$46.04	$55.27
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $58.44 / $90.00 / $117.99	Professional	TC	$58.44	$90.00	$117.99
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $36.56 / $36.56 / $37.15	Facility	26	$36.56	$36.56	$37.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.75 / $132.35 / $164.91	Professional		$87.75	$132.35	$164.91
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.27 / $62.39 / $74.98	Professional	26	$42.27	$62.39	$74.98
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $45.43 / $69.31 / $91.47	Professional	TC	$45.43	$69.31	$91.47
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 $80.39 / $116.28 / $162.05	Professional		$80.39	$116.28	$162.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.88 / $54.29 / $71.86	Professional	26	$37.88	$54.29	$71.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.50 / $62.34 / $94.26	Professional	TC	$42.50	$62.34	$94.26
United Facility/Professional Professional Modifier Low / Median / High Price $63.37 / $88.53 / $194.41	Professional		$63.37	$88.53	$194.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.77 / $32.54 / $83.20	Professional	26	$27.77	$32.54	$83.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.34 / $60.52 / $110.49	Professional	TC	$36.34	$60.52	$110.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $64.81 / $64.81 / $64.81	Professional		$64.81	$64.81	$64.81
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $28.23 / $28.23 / $28.23	Professional	26	$28.23	$28.23	$28.23
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $36.58 / $36.58 / $36.58	Professional	TC	$36.58	$36.58	$36.58