Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.51 / $238.26 / $390.39	Facility	26	$120.51	$238.26	$390.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $461.08 / $594.34 / $1,470.14	Professional		$461.08	$594.34	$1,470.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $140.00 / $339.72	Professional	26	$104.00	$140.00	$339.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $447.88 / $1,073.40	Professional	TC	$335.00	$447.88	$1,073.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $372.04 / $888.85 / $1,000.00	Professional		$372.04	$888.85	$1,000.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $184.47 / $184.47 / $184.47	Professional	26	$184.47	$184.47	$184.47
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $1,000.96 / $1,000.96	Facility	26	$714.15	$1,000.96	$1,000.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $664.94 / $1,177.26 / $5,967.97	Professional		$664.94	$1,177.26	$5,967.97
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $146.44 / $254.60 / $937.83	Professional	26	$146.44	$254.60	$937.83
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $548.86 / $976.95 / $5,400.50	Professional	TC	$548.86	$976.95	$5,400.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $525.24 / $1,035.57 / $1,719.79	Professional		$525.24	$1,035.57	$1,719.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.64 / $193.73 / $336.73	Professional	26	$105.64	$193.73	$336.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $417.28 / $839.44 / $1,447.01	Professional	TC	$417.28	$839.44	$1,447.01
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $118.19 / $242.56 / $1,102.78	Facility	26	$118.19	$242.56	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $578.86 / $1,233.03 / $2,086.55	Professional		$578.86	$1,233.03	$2,086.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.78 / $226.04 / $294.43	Professional	26	$104.78	$226.04	$294.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $522.35 / $1,020.91 / $1,774.09	Professional	TC	$522.35	$1,020.91	$1,774.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.89 / $423.57 / $1,073.12	Professional		$93.89	$423.57	$1,073.12
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $174.35 / $210.53 / $216.41	Facility	26	$174.35	$210.53	$216.41
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $268.35 / $268.35	Professional		$268.35	$268.35	$268.35
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $129.85 / $191.40 / $224.42	Professional	26	$129.85	$191.40	$224.42
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $542.70 / $769.50 / $1,039.74	Professional	TC	$542.70	$769.50	$1,039.74
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $143.60 / $143.60 / $144.87	Facility	26	$143.60	$143.60	$144.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $765.00 / $1,145.67 / $1,462.57	Professional		$765.00	$1,145.67	$1,462.57
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $164.38 / $248.81 / $297.12	Professional	26	$164.38	$248.81	$297.12
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $600.04 / $902.74 / $1,143.92	Professional	TC	$600.04	$902.74	$1,143.92
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 $695.31 / $1,006.86 / $1,493.56	Professional		$695.31	$1,006.86	$1,493.56
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $146.44 / $219.36 / $295.22	Professional	26	$146.44	$219.36	$295.22
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $548.86 / $793.94 / $1,168.16	Professional	TC	$548.86	$793.94	$1,168.16
United Facility/Professional Professional Modifier Low / Median / High Price $477.94 / $810.17 / $1,564.15	Professional		$477.94	$810.17	$1,564.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $97.55 / $123.36 / $314.25	Professional	26	$97.55	$123.36	$314.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $380.39 / $609.15 / $1,225.46	Professional	TC	$380.39	$609.15	$1,225.46
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $546.99 / $546.99 / $546.99	Professional		$546.99	$546.99	$546.99
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $111.80 / $111.80 / $111.80	Professional	26	$111.80	$111.80	$111.80
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $435.19 / $435.19 / $435.19	Professional	TC	$435.19	$435.19	$435.19