Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.35 / $108.29 / $240.95	Facility	26	$93.35	$108.29	$240.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $431.44 / $752.37	Professional		$275.00	$431.44	$752.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.65 / $93.36 / $233.98	Professional	26	$75.65	$93.36	$233.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $214.76 / $318.48 / $559.66	Professional	TC	$214.76	$318.48	$559.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.74 / $250.13 / $280.45	Professional		$109.74	$250.13	$280.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $78.20 / $132.44 / $159.30	Professional	26	$78.20	$132.44	$159.30
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $171.25 / $171.25 / $171.25	Professional	TC	$171.25	$171.25	$171.25
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $773.84 / $773.84	Facility	26	$346.39	$773.84	$773.84
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $387.54 / $710.37 / $3,248.56	Professional		$387.54	$710.37	$3,248.56
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $113.65 / $205.24 / $880.00	Professional	26	$113.65	$205.24	$880.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $282.27 / $511.79 / $2,762.21	Professional	TC	$282.27	$511.79	$2,762.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $291.29 / $595.48 / $1,031.83	Professional		$291.29	$595.48	$1,031.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.18 / $150.29 / $260.30	Professional	26	$82.18	$150.29	$260.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.52 / $436.45 / $823.25	Professional	TC	$208.52	$436.45	$823.25
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $91.68 / $187.74 / $539.79	Facility	26	$91.68	$187.74	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $306.70 / $689.30 / $1,429.72	Professional		$306.70	$689.30	$1,429.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.22 / $175.34 / $227.98	Professional	26	$81.22	$175.34	$227.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $247.84 / $514.21 / $1,227.24	Professional	TC	$247.84	$514.21	$1,227.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $48.06 / $248.09 / $578.88	Professional		$48.06	$248.09	$578.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $134.75 / $162.32 / $167.50	Facility	26	$134.75	$162.32	$167.50
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $155.88 / $155.88 / $155.88	Professional		$155.88	$155.88	$155.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $99.70 / $141.36 / $173.56	Professional	26	$99.70	$141.36	$173.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $235.57 / $392.62 / $763.50	Professional	TC	$235.57	$392.62	$763.50
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $111.44 / $111.44 / $111.97	Facility	26	$111.44	$111.44	$111.97
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $442.30 / $667.72 / $809.64	Professional		$442.30	$667.72	$809.64
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $127.40 / $192.67 / $230.26	Professional	26	$127.40	$192.67	$230.26
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $314.45 / $474.80 / $579.38	Professional	TC	$314.45	$474.80	$579.38
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 $395.93 / $586.82 / $807.04	Professional		$395.93	$586.82	$807.04
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $113.65 / $169.54 / $229.01	Professional	26	$113.65	$169.54	$229.01
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $282.27 / $417.28 / $575.38	Professional	TC	$282.27	$417.28	$575.38
United Facility/Professional Professional Modifier Low / Median / High Price $255.84 / $489.13 / $870.44	Professional		$255.84	$489.13	$870.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $76.08 / $94.02 / $244.28	Professional	26	$76.08	$94.02	$244.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $179.76 / $369.19 / $642.92	Professional	TC	$179.76	$369.19	$642.92
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $303.19 / $303.19 / $303.19	Professional		$303.19	$303.19	$303.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $86.11 / $86.11 / $86.11	Professional	26	$86.11	$86.11	$86.11
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $217.08 / $217.08 / $217.08	Professional	TC	$217.08	$217.08	$217.08