Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.32 / $65.20 / $137.75	Facility	26	$53.32	$65.20	$137.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.46 / $191.16 / $625.00	Professional		$117.46	$191.16	$625.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.60 / $64.18 / $190.00	Professional	26	$42.60	$64.18	$190.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.73 / $91.64 / $205.61	Professional	TC	$71.73	$91.64	$205.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.93 / $179.45 / $231.92	Professional		$95.93	$179.45	$231.92
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.80 / $73.17 / $82.77	Professional	26	$44.80	$73.17	$82.77
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $70.23 / $129.93 / $152.37	Professional	TC	$70.23	$129.93	$152.37
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $211.96 / $211.96	Facility	26	$100.00	$211.96	$211.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $162.62 / $295.06 / $1,005.83	Professional		$162.62	$295.06	$1,005.83
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.22 / $116.44 / $384.53	Professional	26	$64.22	$116.44	$384.53
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $98.41 / $179.61 / $621.29	Professional	TC	$98.41	$179.61	$621.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $137.32 / $225.12 / $376.80	Professional		$137.32	$225.12	$376.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.93 / $86.75 / $143.77	Professional	26	$51.93	$86.75	$143.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.26 / $137.28 / $233.30	Professional	TC	$85.26	$137.28	$233.30
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $46.50 / $100.03 / $168.48	Facility	26	$46.50	$100.03	$168.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $120.90 / $248.86 / $323.74	Professional		$120.90	$248.86	$323.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.50 / $99.04 / $125.03	Professional	26	$46.50	$99.04	$125.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $74.70 / $150.96 / $209.16	Professional	TC	$74.70	$150.96	$209.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.43 / $100.68 / $228.14	Professional		$21.43	$100.68	$228.14
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $76.45 / $92.50 / $95.81	Facility	26	$76.45	$92.50	$95.81
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $115.13 / $132.12 / $132.12	Professional		$115.13	$132.12	$132.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $60.06 / $83.52 / $98.67	Professional	26	$60.06	$83.52	$98.67
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $87.78 / $128.62 / $157.08	Professional	TC	$87.78	$128.62	$157.08
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $62.97 / $62.97 / $63.52	Facility	26	$62.97	$62.97	$63.52
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $182.49 / $269.36 / $329.93	Professional		$182.49	$269.36	$329.93
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.17 / $106.53 / $130.28	Professional	26	$72.17	$106.53	$130.28
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $110.32 / $162.83 / $199.64	Professional	TC	$110.32	$162.83	$199.64
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 $162.62 / $234.38 / $316.17	Professional		$162.62	$234.38	$316.17
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.22 / $93.11 / $124.85	Professional	26	$64.22	$93.11	$124.85
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $98.41 / $141.93 / $191.32	Professional	TC	$98.41	$141.93	$191.32
United Facility/Professional Professional Modifier Low / Median / High Price $124.51 / $132.40 / $322.74	Professional		$124.51	$132.40	$322.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.51 / $53.21 / $132.78	Professional	26	$49.51	$53.21	$132.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.62 / $80.98 / $195.11	Professional	TC	$73.62	$80.98	$195.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $131.46 / $131.46 / $131.46	Professional		$131.46	$131.46	$131.46
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.10 / $49.10 / $49.10	Professional	26	$49.10	$49.10	$49.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $82.36 / $82.36 / $82.36	Professional	TC	$82.36	$82.36	$82.36