Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.30 / $76.40 / $168.26	Facility	26	$53.30	$76.40	$168.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.05 / $171.01 / $401.75	Professional		$93.05	$171.01	$401.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.54 / $59.46 / $115.43	Professional	26	$42.54	$59.46	$115.43
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $44.51 / $66.94 / $116.83	Professional	52	$44.51	$66.94	$116.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.69 / $99.38 / $207.71	Professional	TC	$48.69	$99.38	$207.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.55 / $171.24 / $199.30	Professional		$93.55	$171.24	$199.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.36 / $74.63 / $84.34	Professional	26	$42.36	$74.63	$84.34
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $103.14 / $106.66 / $115.64	Professional	TC	$103.14	$106.66	$115.64
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $140.00 / $333.99 / $333.99	Facility	26	$140.00	$333.99	$333.99
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $91.25 / $162.94 / $3,000.00	Professional		$91.25	$162.94	$3,000.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.96 / $85.28 / $870.13	Professional	26	$44.96	$85.28	$870.13
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $58.33 / $58.33 / $58.33	Professional	52	$58.33	$58.33	$58.33
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.00 / $99.88 / $870.13	Professional	TC	$49.00	$99.88	$870.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $129.94 / $220.71 / $322.45	Professional		$129.94	$220.71	$322.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.61 / $90.18 / $134.38	Professional	26	$53.61	$90.18	$134.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.88 / $134.31 / $195.82	Professional	TC	$75.88	$134.31	$195.82
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $57.26 / $96.66 / $190.24	Facility	26	$57.26	$96.66	$190.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $140.85 / $237.25 / $443.54	Professional		$140.85	$237.25	$443.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.24 / $85.54 / $151.43	Professional	26	$51.24	$85.54	$151.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $87.08 / $149.19 / $278.16	Professional	TC	$87.08	$149.19	$278.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $23.43 / $99.85 / $232.27	Professional		$23.43	$99.85	$232.27
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $70.91 / $85.76 / $116.58	Facility	26	$70.91	$85.76	$116.58
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $59.76 / $87.44 / $120.06	Professional	26	$59.76	$87.44	$120.06
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $68.08 / $156.34 / $210.45	Professional	TC	$68.08	$156.34	$210.45
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $140.00 / $140.00 / $140.00	Facility	26	$140.00	$140.00	$140.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $215.73 / $260.37 / $400.00	Professional		$215.73	$260.37	$400.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $98.34 / $140.00 / $400.00	Professional	26	$98.34	$140.00	$400.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $121.26 / $260.00 / $400.00	Professional	TC	$121.26	$260.00	$400.00
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $270.73 / $270.73 / $459.43	Facility	26	$270.73	$270.73	$459.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $94.10 / $99.05 / $219.75	Professional		$94.10	$99.05	$219.75
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $42.89 / $45.50 / $108.75	Professional	26	$42.89	$45.50	$108.75
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $49.00 / $53.90 / $104.39	Professional	TC	$49.00	$53.90	$104.39
United Facility/Professional Professional Modifier Low / Median / High Price $125.40 / $224.41 / $326.70	Professional		$125.40	$224.41	$326.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.76 / $90.95 / $129.35	Professional	26	$53.76	$90.95	$129.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $76.77 / $135.03 / $192.39	Professional	TC	$76.77	$135.03	$192.39
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $79.51 / $95.51 / $107.73	Professional		$79.51	$95.51	$107.73
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $35.61 / $42.17 / $45.23	Professional	26	$35.61	$42.17	$45.23
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $43.89 / $53.33 / $62.51	Professional	TC	$43.89	$53.33	$62.51