Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.51 / $98.31 / $185.12	Facility	26	$73.51	$98.31	$185.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $225.32 / $329.33 / $636.65	Professional		$225.32	$329.33	$636.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.34 / $86.00 / $207.00	Professional	26	$59.34	$86.00	$207.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $146.49 / $251.06 / $417.62	Professional	TC	$146.49	$251.06	$417.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $307.39 / $350.03 / $532.09	Professional		$307.39	$350.03	$532.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $101.33 / $112.10 / $125.69	Professional	26	$101.33	$112.10	$125.69
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $54.88 / $54.88 / $54.88	Professional	TC	$54.88	$54.88	$54.88
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $612.88 / $612.88 / $612.88	Facility	26	$612.88	$612.88	$612.88
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $265.64 / $474.98 / $1,680.90	Professional		$265.64	$474.98	$1,680.90
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $90.09 / $159.60 / $538.50	Professional	26	$90.09	$159.60	$538.50
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $175.56 / $315.06 / $1,425.00	Professional	TC	$175.56	$315.06	$1,425.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $201.77 / $399.47 / $655.04	Professional		$201.77	$399.47	$655.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.09 / $118.84 / $206.17	Professional	26	$65.09	$118.84	$206.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $133.27 / $270.54 / $452.20	Professional	TC	$133.27	$270.54	$452.20
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $72.53 / $148.56 / $539.79	Facility	26	$72.53	$148.56	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $245.28 / $443.10 / $788.41	Professional		$245.28	$443.10	$788.41
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.48 / $138.72 / $180.90	Professional	26	$64.48	$138.72	$180.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $162.12 / $315.57 / $589.79	Professional	TC	$162.12	$315.57	$589.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $37.05 / $177.58 / $385.40	Professional		$37.05	$177.58	$385.40
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $106.63 / $128.08 / $132.66	Facility	26	$106.63	$128.08	$132.66
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $231.04 / $231.04 / $231.04	Professional		$231.04	$231.04	$231.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $77.59 / $115.14 / $134.75	Professional	26	$77.59	$115.14	$134.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $182.79 / $255.67 / $413.54	Professional	TC	$182.79	$255.67	$413.54
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $88.34 / $88.34 / $88.66	Facility	26	$88.34	$88.34	$88.66
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $295.89 / $446.46 / $539.78	Professional		$295.89	$446.46	$539.78
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $100.69 / $151.49 / $184.69	Professional	26	$100.69	$151.49	$184.69
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $194.86 / $293.70 / $359.78	Professional	TC	$194.86	$293.70	$359.78
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 $265.64 / $392.36 / $536.05	Professional		$265.64	$392.36	$536.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $90.09 / $134.25 / $181.18	Professional	26	$90.09	$134.25	$181.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $175.56 / $258.12 / $350.02	Professional	TC	$175.56	$258.12	$350.02
United Facility/Professional Professional Modifier Low / Median / High Price $174.85 / $283.58 / $563.29	Professional		$174.85	$283.58	$563.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.13 / $75.20 / $188.76	Professional	26	$60.13	$75.20	$188.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.72 / $210.03 / $379.87	Professional	TC	$114.72	$210.03	$379.87
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $212.14 / $212.14 / $212.14	Professional		$212.14	$212.14	$212.14
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $67.94 / $67.94 / $67.94	Professional	26	$67.94	$67.94	$67.94
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $144.19 / $144.19 / $144.19	Professional	TC	$144.19	$144.19	$144.19