Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.31 / $157.76 / $308.41	Facility	26	$95.31	$157.76	$308.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $344.36 / $488.59 / $857.99	Professional		$344.36	$488.59	$857.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.39 / $140.00 / $268.36	Professional	26	$86.39	$140.00	$268.36
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $148.16 / $212.50 / $429.00	Professional	52	$148.16	$212.50	$429.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $238.38 / $340.00 / $589.63	Professional	TC	$238.38	$340.00	$589.63
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $135.16 / $138.83 / $145.05	Professional	26	$135.16	$138.83	$145.05
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $513.22 / $513.22 / $513.22	Professional	52	$513.22	$513.22	$513.22
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $789.76 / $789.76 / $789.76	Facility	26	$789.76	$789.76	$789.76
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $391.78 / $671.13 / $3,445.62	Professional		$391.78	$671.13	$3,445.62
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $115.96 / $207.36 / $693.90	Professional	26	$115.96	$207.36	$693.90
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $47.98 / $47.98 / $276.58	Professional	52	$47.98	$47.98	$276.58
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $275.81 / $494.27 / $2,996.90	Professional	TC	$275.81	$494.27	$2,996.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $299.22 / $600.82 / $1,046.71	Professional		$299.22	$600.82	$1,046.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.88 / $153.32 / $265.68	Professional	26	$83.88	$153.32	$265.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $214.01 / $426.27 / $806.68	Professional	TC	$214.01	$426.27	$806.68
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $93.52 / $191.77 / $1,102.78	Facility	26	$93.52	$191.77	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $388.32 / $700.24 / $1,402.56	Professional		$388.32	$700.24	$1,402.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.08 / $178.86 / $232.59	Professional	26	$83.08	$178.86	$232.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $280.52 / $521.36 / $1,198.43	Professional	TC	$280.52	$521.36	$1,198.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $56.10 / $268.38 / $603.77	Professional		$56.10	$268.38	$603.77
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $137.50 / $165.65 / $170.85	Facility	26	$137.50	$165.65	$170.85
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $298.17 / $298.17 / $376.90	Professional		$298.17	$298.17	$376.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $118.35 / $163.19 / $190.50	Professional	26	$118.35	$163.19	$190.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $305.02 / $434.83 / $835.10	Professional	TC	$305.02	$434.83	$835.10
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $113.70 / $113.70 / $114.25	Facility	26	$113.70	$113.70	$114.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $436.11 / $656.69 / $823.68	Professional		$436.11	$656.69	$823.68
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $129.97 / $196.60 / $234.94	Professional	26	$129.97	$196.60	$234.94
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $305.69 / $459.84 / $587.04	Professional	TC	$305.69	$459.84	$587.04
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $851.78	Facility	26	$714.15	$714.15	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $391.78 / $577.13 / $835.09	Professional		$391.78	$577.13	$835.09
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $115.96 / $173.00 / $233.60	Professional	26	$115.96	$173.00	$233.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $275.81 / $404.13 / $601.48	Professional	TC	$275.81	$404.13	$601.48
United Facility/Professional Professional Modifier Low / Median / High Price $266.58 / $533.15 / $904.05	Professional		$266.58	$533.15	$904.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.26 / $99.27 / $246.45	Professional	26	$77.26	$99.27	$246.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $188.96 / $386.53 / $681.10	Professional	TC	$188.96	$386.53	$681.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $313.68 / $313.68 / $313.68	Professional		$313.68	$313.68	$313.68
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $87.91 / $87.91 / $87.91	Professional	26	$87.91	$87.91	$87.91
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $225.77 / $225.77 / $225.77	Professional	TC	$225.77	$225.77	$225.77