Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.17 / $45.35 / $119.69	Facility	26	$37.17	$45.35	$119.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.34 / $179.12 / $450.00	Professional		$113.34	$179.12	$450.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.77 / $50.95 / $124.15	Professional	26	$30.77	$50.95	$124.15
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $53.19 / $75.03 / $273.00	Professional	52	$53.19	$75.03	$273.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.59 / $112.89 / $245.01	Professional	TC	$83.59	$112.89	$245.01
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $92.20 / $168.45 / $253.35	Professional		$92.20	$168.45	$253.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.60 / $52.80 / $59.20	Professional	26	$25.60	$52.80	$59.20
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $48.52 / $48.52 / $48.52	Professional	52	$48.52	$48.52	$48.52
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $72.79 / $158.41	Professional	TC	$43.65	$72.79	$158.41
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $77.65 / $148.36 / $148.36	Facility	26	$77.65	$148.36	$148.36
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $166.78 / $307.52 / $1,030.88	Professional		$166.78	$307.52	$1,030.88
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.28 / $78.45 / $290.60	Professional	26	$45.28	$78.45	$290.60
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $18.75 / $18.75 / $76.95	Professional	52	$18.75	$18.75	$76.95
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $121.41 / $218.38 / $762.23	Professional	TC	$121.41	$218.38	$762.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $129.87 / $219.62 / $386.50	Professional		$129.87	$219.62	$386.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.29 / $60.51 / $100.37	Professional	26	$36.29	$60.51	$100.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $88.48 / $161.04 / $285.68	Professional	TC	$88.48	$161.04	$285.68
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $36.76 / $71.27 / $118.68	Facility	26	$36.76	$71.27	$118.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $108.81 / $226.20 / $322.72	Professional		$108.81	$226.20	$322.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.76 / $69.59 / $87.16	Professional	26	$36.76	$69.59	$87.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $70.73 / $165.76 / $239.52	Professional	TC	$70.73	$165.76	$239.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.80 / $143.84 / $310.91	Professional		$28.80	$143.84	$310.91
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.35 / $64.70 / $66.33	Facility	26	$53.35	$64.70	$66.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $39.79 / $57.60 / $73.50	Professional	26	$39.79	$57.60	$73.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $104.58 / $149.40 / $203.71	Professional	TC	$104.58	$149.40	$203.71
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $44.33 / $44.33 / $44.39	Facility	26	$44.33	$44.33	$44.39
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.45 / $274.68 / $335.55	Professional		$185.45	$274.68	$335.55
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.03 / $75.33 / $90.92	Professional	26	$51.03	$75.33	$90.92
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $135.06 / $199.36 / $244.64	Professional	TC	$135.06	$199.36	$244.64
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 $166.78 / $239.02 / $320.64	Professional		$166.78	$239.02	$320.64
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $45.28 / $65.55 / $87.13	Professional	26	$45.28	$65.55	$87.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $121.51 / $173.47 / $234.32	Professional	TC	$121.51	$173.47	$234.32
United Facility/Professional Professional Modifier Low / Median / High Price $118.96 / $134.56 / $342.92	Professional		$118.96	$134.56	$342.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.54 / $38.90 / $90.27	Professional	26	$34.54	$38.90	$90.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $84.76 / $97.65 / $238.85	Professional	TC	$84.76	$97.65	$238.85
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.76 / $134.76 / $134.76	Professional		$134.76	$134.76	$134.76
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $34.36 / $34.36 / $34.36	Professional	26	$34.36	$34.36	$34.36
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $100.39 / $100.39 / $100.39	Professional	TC	$100.39	$100.39	$100.39