Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.03 / $50.09 / $101.22	Facility	26	$41.03	$50.09	$101.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.73 / $162.94 / $418.73	Professional		$124.73	$162.94	$418.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.71 / $41.03 / $103.02	Professional	26	$32.71	$41.03	$103.02
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $65.84 / $186.15 / $726.00	Professional	52	$65.84	$186.15	$726.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.17 / $114.52 / $244.84	Professional	TC	$91.17	$114.52	$244.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $128.32 / $239.96 / $271.93	Professional		$128.32	$239.96	$271.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.79 / $58.10 / $65.14	Professional	26	$37.79	$58.10	$65.14
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $25.12 / $67.98 / $87.53	Professional	52	$25.12	$67.98	$87.53
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $172.25 / $172.25 / $202.00	Professional	TC	$172.25	$172.25	$202.00
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $75.31 / $163.47 / $163.47	Facility	26	$75.31	$163.47	$163.47
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $164.32 / $303.26 / $1,104.75	Professional		$164.32	$303.26	$1,104.75
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.43 / $85.68 / $297.23	Professional	26	$49.43	$85.68	$297.23
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $20.63 / $86.80 / $113.10	Professional	52	$20.63	$86.80	$113.10
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $127.51 / $219.27 / $807.60	Professional	TC	$127.51	$219.27	$807.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.47 / $240.21 / $414.37	Professional		$141.47	$240.21	$414.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.57 / $65.34 / $108.50	Professional	26	$37.57	$65.34	$108.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.80 / $175.54 / $308.66	Professional	TC	$100.80	$175.54	$308.66
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $35.34 / $79.92 / $108.75	Facility	26	$35.34	$79.92	$108.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $135.47 / $276.75 / $365.50	Professional		$135.47	$276.75	$365.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.34 / $76.05 / $99.47	Professional	26	$35.34	$76.05	$99.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $100.75 / $200.69 / $271.70	Professional	TC	$100.75	$200.69	$271.70
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 $58.85 / $71.14 / $73.03	Facility	26	$58.85	$71.14	$73.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.10 / $58.85 / $77.70	Professional	26	$44.10	$58.85	$77.70
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $131.32 / $157.60 / $207.20	Professional	TC	$131.32	$157.60	$207.20
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $48.47 / $48.47 / $48.90	Facility	26	$48.47	$48.47	$48.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $198.74 / $297.22 / $365.57	Professional		$198.74	$297.22	$365.57
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.75 / $84.14 / $101.86	Professional	26	$55.75	$84.14	$101.86
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $142.99 / $214.40 / $263.64	Professional	TC	$142.99	$214.40	$263.64
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $187.50 / $187.50 / $257.25	Facility	26	$187.50	$187.50	$257.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $176.95 / $263.50 / $358.68	Professional		$176.95	$263.50	$358.68
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.99 / $74.04 / $100.41	Professional	26	$49.99	$74.04	$100.41
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $129.41 / $190.33 / $259.36	Professional	TC	$129.41	$190.33	$259.36
United Facility/Professional Professional Modifier Low / Median / High Price $144.13 / $172.74 / $365.76	Professional		$144.13	$172.74	$365.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.26 / $48.54 / $102.61	Professional	26	$40.26	$48.54	$102.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.83 / $128.40 / $263.14	Professional	TC	$104.83	$128.40	$263.14
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $146.99 / $146.99 / $146.99	Professional		$146.99	$146.99	$146.99
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.79 / $37.79 / $37.79	Professional	26	$37.79	$37.79	$37.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $109.19 / $109.19 / $109.19	Professional	TC	$109.19	$109.19	$109.19