Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.48 / $158.15 / $310.76	Facility	26	$96.48	$158.15	$310.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $402.08 / $475.00 / $1,320.50	Professional		$402.08	$475.00	$1,320.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.69 / $140.00 / $271.60	Professional	26	$87.69	$140.00	$271.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $292.10 / $367.42 / $818.13	Professional	TC	$292.10	$367.42	$818.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $274.17 / $579.25 / $665.64	Professional		$274.17	$579.25	$665.64
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.92 / $145.31 / $146.16	Professional	26	$46.92	$145.31	$146.16
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $496.69 / $496.69 / $496.69	Professional	TC	$496.69	$496.69	$496.69
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $796.16 / $796.16	Facility	26	$714.15	$796.16	$796.16
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $500.35 / $866.88 / $5,311.18	Professional		$500.35	$866.88	$5,311.18
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $117.35 / $204.51 / $808.00	Professional	26	$117.35	$204.51	$808.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $383.00 / $699.23 / $4,858.99	Professional	TC	$383.00	$699.23	$4,858.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $389.79 / $865.88 / $1,448.21	Professional		$389.79	$865.88	$1,448.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.74 / $154.53 / $267.80	Professional	26	$84.74	$154.53	$267.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $301.77 / $694.87 / $1,285.08	Professional	TC	$301.77	$694.87	$1,285.08
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $94.25 / $193.29 / $1,102.78	Facility	26	$94.25	$193.29	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $549.49 / $1,015.30 / $2,077.50	Professional		$549.49	$1,015.30	$2,077.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.70 / $180.27 / $234.44	Professional	26	$83.70	$180.27	$234.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $491.04 / $851.49 / $1,855.99	Professional	TC	$491.04	$851.49	$1,855.99
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.67 / $330.19 / $823.24	Professional		$75.67	$330.19	$823.24
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.60 / $166.99 / $172.19	Facility	26	$138.60	$166.99	$172.19
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $298.17 / $298.17 / $298.17	Professional		$298.17	$298.17	$298.17
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.91 / $153.00 / $177.33	Professional	26	$102.91	$153.00	$177.33
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $454.98 / $839.04 / $1,336.35	Professional	TC	$454.98	$839.04	$1,336.35
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $115.06 / $115.06 / $115.16	Facility	26	$115.06	$115.06	$115.16
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $556.22 / $839.37 / $1,047.64	Professional		$556.22	$839.37	$1,047.64
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $131.44 / $198.17 / $239.90	Professional	26	$131.44	$198.17	$239.90
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $424.77 / $649.05 / $810.58	Professional	TC	$424.77	$649.05	$810.58
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 $500.35 / $737.67 / $1,109.11	Professional		$500.35	$737.67	$1,109.11
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $117.35 / $174.38 / $235.44	Professional	26	$117.35	$174.38	$235.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $383.00 / $563.29 / $869.35	Professional	TC	$383.00	$563.29	$869.35
United Facility/Professional Professional Modifier Low / Median / High Price $336.52 / $677.94 / $1,148.10	Professional		$336.52	$677.94	$1,148.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $78.54 / $101.45 / $246.53	Professional	26	$78.54	$101.45	$246.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.98 / $526.33 / $935.46	Professional	TC	$257.98	$526.33	$935.46
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $403.42 / $403.42 / $403.42	Professional		$403.42	$403.42	$403.42
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $88.59 / $88.59 / $88.59	Professional	26	$88.59	$88.59	$88.59
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $314.83 / $314.83 / $314.83	Professional	TC	$314.83	$314.83	$314.83