Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $122.75 / $201.04 / $357.05	Facility	26	$122.75	$201.04	$357.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $402.08 / $522.50 / $1,058.81	Professional		$402.08	$522.50	$1,058.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.37 / $161.00 / $344.64	Professional	26	$104.37	$161.00	$344.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $270.02 / $340.00 / $692.74	Professional	TC	$270.02	$340.00	$692.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $254.85 / $609.44 / $1,000.00	Professional		$254.85	$609.44	$1,000.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.71 / $181.76 / $289.98	Professional	26	$84.71	$181.76	$289.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $473.16 / $473.16 / $473.16	Professional	TC	$473.16	$473.16	$473.16
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,016.96 / $1,016.96 / $1,016.96	Facility	26	$1,016.96	$1,016.96	$1,016.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $465.23 / $794.09 / $6,199.75	Professional		$465.23	$794.09	$6,199.75
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $148.76 / $260.52 / $931.20	Professional	26	$148.76	$260.52	$931.20
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $316.47 / $570.25 / $5,551.18	Professional	TC	$316.47	$570.25	$5,551.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $353.46 / $710.69 / $1,331.66	Professional		$353.46	$710.69	$1,331.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.99 / $198.24 / $354.36	Professional	26	$107.99	$198.24	$354.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $244.94 / $487.91 / $985.54	Professional	TC	$244.94	$487.91	$985.54
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $119.66 / $248.72 / $1,102.78	Facility	26	$119.66	$248.72	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $460.47 / $830.35 / $1,814.86	Professional		$460.47	$830.35	$1,814.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $113.15 / $240.50 / $312.20	Professional	26	$113.15	$240.50	$312.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $322.54 / $606.36 / $1,530.24	Professional	TC	$322.54	$606.36	$1,530.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $57.59 / $274.36 / $658.21	Professional		$57.59	$274.36	$658.21
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $177.10 / $213.86 / $219.09	Facility	26	$177.10	$213.86	$219.09
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $135.79 / $216.03 / $248.58	Professional	26	$135.79	$216.03	$248.58
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $332.99 / $501.76 / $981.47	Professional	TC	$332.99	$501.76	$981.47
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $145.87 / $145.87 / $147.15	Facility	26	$145.87	$145.87	$147.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $516.02 / $777.16 / $981.86	Professional		$516.02	$777.16	$981.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $167.02 / $253.22 / $302.33	Professional	26	$167.02	$253.22	$302.33
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $348.99 / $523.62 / $668.46	Professional	TC	$348.99	$523.62	$668.46
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 $465.23 / $683.00 / $990.52	Professional		$465.23	$683.00	$990.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $148.76 / $222.82 / $298.89	Professional	26	$148.76	$222.82	$298.89
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $316.47 / $460.18 / $691.61	Professional	TC	$316.47	$460.18	$691.61
United Facility/Professional Professional Modifier Low / Median / High Price $317.50 / $625.97 / $1,149.67	Professional		$317.50	$625.97	$1,149.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $99.70 / $131.47 / $316.57	Professional	26	$99.70	$131.47	$316.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $217.80 / $435.61 / $843.51	Professional	TC	$217.80	$435.61	$843.51
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $369.36 / $369.36 / $369.36	Professional		$369.36	$369.36	$369.36
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $113.60 / $113.60 / $113.60	Professional	26	$113.60	$113.60	$113.60
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $255.76 / $255.76 / $255.76	Professional	TC	$255.76	$255.76	$255.76