Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $122.75 / $192.71 / $353.51	Facility	26	$122.75	$192.71	$353.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $398.81 / $522.50 / $1,020.07	Professional		$398.81	$522.50	$1,020.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.81 / $157.83 / $344.64	Professional	26	$106.81	$157.83	$344.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $269.19 / $340.00 / $692.74	Professional	TC	$269.19	$340.00	$692.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $254.34 / $608.14 / $951.98	Professional		$254.34	$608.14	$951.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.71 / $174.72 / $210.16	Professional	26	$84.71	$174.72	$210.16
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $471.69 / $471.69 / $471.69	Professional	TC	$471.69	$471.69	$471.69
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 $463.85 / $792.51 / $6,146.58	Professional		$463.85	$792.51	$6,146.58
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $148.76 / $257.75 / $921.60	Professional	26	$148.76	$257.75	$921.60
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $315.08 / $568.66 / $5,551.18	Professional	TC	$315.08	$568.66	$5,551.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $352.72 / $709.26 / $1,310.44	Professional		$352.72	$709.26	$1,310.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.99 / $198.39 / $342.10	Professional	26	$107.99	$198.39	$342.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $243.28 / $484.79 / $979.54	Professional	TC	$243.28	$484.79	$979.54
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $120.03 / $245.61 / $1,102.78	Facility	26	$120.03	$245.61	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $459.62 / $828.81 / $1,790.88	Professional		$459.62	$828.81	$1,790.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $106.64 / $233.64 / $298.41	Professional	26	$106.64	$233.64	$298.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $321.27 / $603.08 / $1,529.44	Professional	TC	$321.27	$603.08	$1,529.44
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 / $219.76	Facility	26	$177.10	$213.86	$219.76
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 $130.65 / $196.80 / $229.60	Professional	26	$130.65	$196.80	$229.60
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $313.16 / $485.08 / $1,038.40	Professional	TC	$313.16	$485.08	$1,038.40
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 $514.98 / $775.59 / $979.99	Professional		$514.98	$775.59	$979.99
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $166.44 / $250.83 / $302.33	Professional	26	$166.44	$250.83	$302.33
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $347.96 / $522.04 / $666.45	Professional	TC	$347.96	$522.04	$666.45
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 $463.85 / $681.62 / $988.68	Professional		$463.85	$681.62	$988.68
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $148.76 / $222.82 / $299.82	Professional	26	$148.76	$222.82	$299.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $315.08 / $458.80 / $688.86	Professional	TC	$315.08	$458.80	$688.86
United Facility/Professional Professional Modifier Low / Median / High Price $316.89 / $638.40 / $1,147.35	Professional		$316.89	$638.40	$1,147.35
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 $217.19 / $446.05 / $816.89	Professional	TC	$217.19	$446.05	$816.89
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $368.57 / $368.57 / $368.57	Professional		$368.57	$368.57	$368.57
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 $254.97 / $254.97 / $254.97	Professional	TC	$254.97	$254.97	$254.97