Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.57 / $39.70 / $79.87	Facility	26	$32.57	$39.70	$79.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.14 / $63.60 / $153.44	Professional		$50.14	$63.60	$153.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.57 / $32.58 / $83.03	Professional	26	$26.57	$32.58	$83.03
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $47.78 / $82.35 / $285.00	Professional	52	$47.78	$82.35	$285.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.79 / $31.02 / $67.65	Professional	TC	$21.79	$31.02	$67.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.70 / $97.13 / $107.61	Professional		$85.70	$97.13	$107.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $45.74 / $51.28	Professional	26	$29.75	$45.74	$51.28
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $10.29 / $24.02 / $35.94	Professional	52	$10.29	$24.02	$35.94
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $40.46 / $44.81 / $52.56	Professional	TC	$40.46	$44.81	$52.56
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $49.41 / $128.65 / $128.65	Facility	26	$49.41	$128.65	$128.65
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $72.06 / $124.89 / $442.65	Professional		$72.06	$124.89	$442.65
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.72 / $68.08 / $233.10	Professional	26	$39.72	$68.08	$233.10
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $16.23 / $33.46 / $43.60	Professional	52	$16.23	$33.46	$43.60
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.46 / $56.71 / $209.63	Professional	TC	$32.46	$56.71	$209.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.33 / $96.63 / $163.30	Professional		$55.33	$96.63	$163.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.45 / $52.00 / $85.20	Professional	26	$30.45	$52.00	$85.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.04 / $44.80 / $80.31	Professional	TC	$25.04	$44.80	$80.31
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $27.90 / $63.68 / $86.25	Facility	26	$27.90	$63.68	$86.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $57.80 / $116.18 / $153.33	Professional		$57.80	$116.18	$153.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.90 / $59.85 / $78.45	Professional	26	$27.90	$59.85	$78.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.34 / $50.70 / $70.03	Professional	TC	$25.34	$50.70	$70.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.26 / $65.74 / $147.09	Professional		$14.26	$65.74	$147.09
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $46.20 / $56.03 / $57.62	Facility	26	$46.20	$56.03	$57.62
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $34.17 / $46.20 / $63.00	Professional	26	$34.17	$46.20	$63.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.14 / $39.60 / $54.00	Professional	TC	$28.14	$39.60	$54.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $38.39 / $38.39 / $38.96	Facility	26	$38.39	$38.39	$38.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.45 / $120.74 / $148.51	Professional		$81.45	$120.74	$148.51
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.39 / $65.44 / $79.97	Professional	26	$44.39	$65.44	$79.97
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $37.17 / $56.62 / $68.53	Professional	TC	$37.17	$56.62	$68.53
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $49.41 / $49.41 / $64.77	Facility	26	$49.41	$49.41	$64.77
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $72.06 / $107.95 / $143.47	Professional		$72.06	$107.95	$143.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $41.28 / $58.13 / $78.83	Professional	26	$41.28	$58.13	$78.83
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.64 / $49.64 / $65.92	Professional	TC	$33.64	$49.64	$65.92
United Facility/Professional Professional Modifier Low / Median / High Price $58.89 / $73.78 / $160.29	Professional		$58.89	$73.78	$160.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.82 / $37.99 / $84.01	Professional	26	$31.82	$37.99	$84.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.96 / $31.82 / $68.40	Professional	TC	$26.96	$31.82	$68.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $58.17 / $58.17 / $58.17	Professional		$58.17	$58.17	$58.17
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $29.75 / $29.75	Professional	26	$29.75	$29.75	$29.75
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $28.41 / $28.41 / $28.41	Professional	TC	$28.41	$28.41	$28.41