Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.76 / $188.05 / $333.97	Facility	26	$114.76	$188.05	$333.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $402.08 / $522.50 / $1,295.84	Professional		$402.08	$522.50	$1,295.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $154.00 / $369.88	Professional	26	$104.00	$154.00	$369.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $282.87 / $348.53 / $758.77	Professional	TC	$282.87	$348.53	$758.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $269.37 / $648.07 / $1,014.62	Professional		$269.37	$648.07	$1,014.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $163.43 / $175.28 / $271.19	Professional	26	$163.43	$175.28	$271.19
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $530.10 / $530.10 / $530.10	Professional	TC	$530.10	$530.10	$530.10
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $950.80 / $950.80	Facility	26	$714.15	$950.80	$950.80
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $494.34 / $842.48 / $5,981.06	Professional		$494.34	$842.48	$5,981.06
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $139.06 / $240.60 / $883.52	Professional	26	$139.06	$240.60	$883.52
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $355.28 / $638.58 / $5,438.76	Professional	TC	$355.28	$638.58	$5,438.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $382.62 / $751.12 / $1,340.22	Professional		$382.62	$751.12	$1,340.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.66 / $183.49 / $319.81	Professional	26	$100.66	$183.49	$319.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $277.76 / $595.20 / $1,032.73	Professional	TC	$277.76	$595.20	$1,032.73
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $111.93 / $229.38 / $1,102.78	Facility	26	$111.93	$229.38	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $481.00 / $882.39 / $1,806.07	Professional		$481.00	$882.39	$1,806.07
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $99.20 / $214.07 / $278.68	Professional	26	$99.20	$214.07	$278.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $360.31 / $678.97 / $1,567.81	Professional	TC	$360.31	$678.97	$1,567.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $66.21 / $300.95 / $745.03	Professional		$66.21	$300.95	$745.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $165.55 / $200.09 / $205.02	Facility	26	$165.55	$200.09	$205.02
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $136.80 / $179.36 / $215.73	Professional	26	$136.80	$179.36	$215.73
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $408.03 / $595.58 / $921.50	Professional	TC	$408.03	$595.58	$921.50
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $136.35 / $136.35 / $137.56	Facility	26	$136.35	$136.35	$137.56
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $547.46 / $822.83 / $1,043.64	Professional		$547.46	$822.83	$1,043.64
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $155.65 / $232.97 / $282.67	Professional	26	$155.65	$232.97	$282.67
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $391.26 / $597.86 / $747.87	Professional	TC	$391.26	$597.86	$747.87
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $1,538.06	Facility	26	$714.15	$714.15	$1,538.06
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $494.34 / $723.14 / $1,052.14	Professional		$494.34	$723.14	$1,052.14
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $139.06 / $208.29 / $279.58	Professional	26	$139.06	$208.29	$279.58
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $355.28 / $514.85 / $772.55	Professional	TC	$355.28	$514.85	$772.55
United Facility/Professional Professional Modifier Low / Median / High Price $336.21 / $633.41 / $1,144.03	Professional		$336.21	$633.41	$1,144.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $92.95 / $120.24 / $298.45	Professional	26	$92.95	$120.24	$298.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $243.26 / $500.83 / $887.31	Professional	TC	$243.26	$500.83	$887.31
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $392.77 / $392.77 / $392.77	Professional		$392.77	$392.77	$392.77
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $106.23 / $106.23 / $106.23	Professional	26	$106.23	$106.23	$106.23
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $286.54 / $286.54 / $286.54	Professional	TC	$286.54	$286.54	$286.54