Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.28 / $52.90 / $106.77	Facility	26	$43.28	$52.90	$106.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.30 / $154.47 / $485.38	Professional		$120.30	$154.47	$485.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.46 / $43.29 / $100.06	Professional	26	$34.46	$43.29	$100.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $84.99 / $108.71 / $231.78	Professional	TC	$84.99	$108.71	$231.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $98.60 / $236.64 / $341.81	Professional		$98.60	$236.64	$341.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.28 / $61.35 / $73.78	Professional	26	$30.28	$61.35	$73.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $97.59 / $97.59 / $97.59	Professional	TC	$97.59	$97.59	$97.59
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $80.31 / $172.60 / $172.60	Facility	26	$80.31	$172.60	$172.60
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $171.83 / $297.64 / $1,080.23	Professional		$171.83	$297.64	$1,080.23
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.67 / $91.63 / $316.35	Professional	26	$52.67	$91.63	$316.35
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $84.35 / $84.35 / $84.35	Professional	52	$84.35	$84.35	$84.35
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $121.04 / $207.40 / $763.88	Professional	TC	$121.04	$207.40	$763.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.57 / $235.55 / $404.64	Professional		$138.57	$235.55	$404.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.32 / $69.86 / $115.66	Professional	26	$40.32	$69.86	$115.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.40 / $166.19 / $291.92	Professional	TC	$95.40	$166.19	$291.92
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $37.82 / $84.59 / $114.37	Facility	26	$37.82	$84.59	$114.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $132.68 / $271.82 / $357.20	Professional		$132.68	$271.82	$357.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.82 / $81.68 / $104.61	Professional	26	$37.82	$81.68	$104.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $99.41 / $203.90 / $270.97	Professional	TC	$99.41	$203.90	$270.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.59 / $146.95 / $312.31	Professional		$29.59	$146.95	$312.31
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $62.65 / $75.15 / $77.52	Facility	26	$62.65	$75.15	$77.52
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $46.91 / $64.92 / $78.18	Professional	26	$46.91	$64.92	$78.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $120.84 / $153.27 / $180.91	Professional	TC	$120.84	$153.27	$180.91
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $51.64 / $51.64 / $52.10	Facility	26	$51.64	$51.64	$52.10
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $193.83 / $291.02 / $357.88	Professional		$193.83	$291.02	$357.88
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.85 / $88.24 / $106.85	Professional	26	$58.85	$88.24	$106.85
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $135.24 / $204.92 / $245.57	Professional	TC	$135.24	$204.92	$245.57
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $177.35 / $177.35 / $243.57	Facility	26	$177.35	$177.35	$243.57
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $173.71 / $258.35 / $352.25	Professional		$173.71	$258.35	$352.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $53.26 / $78.43 / $106.69	Professional	26	$53.26	$78.43	$106.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $122.41 / $180.25 / $245.56	Professional	TC	$122.41	$180.25	$245.56
United Facility/Professional Professional Modifier Low / Median / High Price $140.78 / $172.41 / $357.21	Professional		$140.78	$172.41	$357.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.71 / $53.36 / $114.25	Professional	26	$43.71	$53.36	$114.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $99.56 / $120.52 / $248.91	Professional	TC	$99.56	$120.52	$248.91
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $143.41 / $143.41 / $143.41	Professional		$143.41	$143.41	$143.41
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $39.88 / $39.88 / $39.88	Professional	26	$39.88	$39.88	$39.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $103.55 / $103.55 / $103.55	Professional	TC	$103.55	$103.55	$103.55