Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.76 / $111.65 / $220.18	Facility	26	$67.76	$111.65	$220.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $212.39 / $314.94 / $520.79	Professional		$212.39	$314.94	$520.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.86 / $72.87 / $170.09	Professional	26	$54.86	$72.87	$170.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $139.69 / $243.83 / $437.08	Professional	TC	$139.69	$243.83	$437.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.02 / $289.82 / $289.82	Professional		$138.02	$289.82	$289.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.24 / $96.36 / $109.21	Professional	26	$33.24	$96.36	$109.21
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $254.36 / $254.36 / $254.36	Professional	TC	$254.36	$254.36	$254.36
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $565.04 / $565.04 / $565.04	Facility	26	$565.04	$565.04	$565.04
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $249.48 / $427.46 / $1,897.57	Professional		$249.48	$427.46	$1,897.57
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.16 / $147.16 / $497.63	Professional	26	$83.16	$147.16	$497.63
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $166.78 / $302.14 / $1,600.00	Professional	TC	$166.78	$302.14	$1,600.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.22 / $367.95 / $625.44	Professional		$190.22	$367.95	$625.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.81 / $109.26 / $190.10	Professional	26	$59.81	$109.26	$190.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $127.28 / $252.38 / $447.22	Professional	TC	$127.28	$252.38	$447.22
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $66.64 / $136.21 / $539.79	Facility	26	$66.64	$136.21	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $203.67 / $417.85 / $753.13	Professional		$203.67	$417.85	$753.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.21 / $127.46 / $165.49	Professional	26	$59.21	$127.46	$165.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $148.18 / $291.49 / $590.03	Professional	TC	$148.18	$291.49	$590.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.92 / $156.16 / $375.54	Professional		$30.92	$156.16	$375.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $98.38 / $118.06 / $121.94	Facility	26	$98.38	$118.06	$121.94
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $155.88	Professional		$140.29	$140.29	$155.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.40 / $108.46 / $130.05	Professional	26	$72.40	$108.46	$130.05
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $149.54 / $248.92 / $422.82	Professional	TC	$149.54	$248.92	$422.82
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $81.54 / $81.54 / $81.80	Facility	26	$81.54	$81.54	$81.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $278.37 / $420.47 / $513.97	Professional		$278.37	$420.47	$513.97
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $92.47 / $139.71 / $170.41	Professional	26	$92.47	$139.71	$170.41
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $185.58 / $279.52 / $348.19	Professional	TC	$185.58	$279.52	$348.19
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $346.39 / $851.78	Facility	26	$346.39	$346.39	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $249.94 / $369.53 / $504.31	Professional		$249.94	$369.53	$504.31
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.16 / $123.87 / $166.47	Professional	26	$83.16	$123.87	$166.47
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $166.78 / $245.66 / $339.95	Professional	TC	$166.78	$245.66	$339.95
United Facility/Professional Professional Modifier Low / Median / High Price $165.04 / $263.17 / $522.12	Professional		$165.04	$263.17	$522.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.22 / $71.50 / $173.34	Professional	26	$55.22	$71.50	$173.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.82 / $219.64 / $379.43	Professional	TC	$109.82	$219.64	$379.43
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $200.14 / $200.14 / $200.14	Professional		$200.14	$200.14	$200.14
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $62.65 / $62.65 / $62.65	Professional	26	$62.65	$62.65	$62.65
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $137.49 / $137.49 / $137.49	Professional	TC	$137.49	$137.49	$137.49