Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.45 / $192.43 / $390.39	Facility	26	$117.45	$192.43	$390.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $391.88 / $522.50 / $1,398.33	Professional		$391.88	$522.50	$1,398.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $145.65 / $331.05	Professional	26	$104.00	$145.65	$331.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $282.87 / $354.60 / $748.87	Professional	TC	$282.87	$354.60	$748.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $340.35 / $643.04 / $1,014.56	Professional		$340.35	$643.04	$1,014.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $81.08 / $179.37 / $201.11	Professional	26	$81.08	$179.37	$201.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $264.79 / $519.87 / $519.87	Professional	TC	$264.79	$519.87	$519.87
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $973.04 / $973.04	Facility	26	$714.15	$973.04	$973.04
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $493.42 / $838.52 / $6,025.38	Professional		$493.42	$838.52	$6,025.38
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $142.76 / $248.62 / $891.52	Professional	26	$142.76	$248.62	$891.52
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $350.66 / $633.03 / $5,457.89	Professional	TC	$350.66	$633.03	$5,457.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $380.68 / $751.15 / $1,362.63	Professional		$380.68	$751.15	$1,362.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.98 / $189.85 / $327.32	Professional	26	$102.98	$189.85	$327.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $272.44 / $584.78 / $1,050.71	Professional	TC	$272.44	$584.78	$1,050.71
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $115.24 / $235.03 / $1,102.78	Facility	26	$115.24	$235.03	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $508.02 / $930.60 / $1,832.45	Professional		$508.02	$930.60	$1,832.45
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $102.30 / $220.46 / $285.54	Professional	26	$102.30	$220.46	$285.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $383.65 / $691.83 / $1,582.21	Professional	TC	$383.65	$691.83	$1,582.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $66.21 / $300.95 / $745.03	Professional		$66.21	$300.95	$745.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $169.40 / $204.76 / $216.41	Facility	26	$169.40	$204.76	$216.41
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $345.93 / $345.93 / $345.93	Professional		$345.93	$345.93	$345.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $148.94 / $191.40 / $221.77	Professional	26	$148.94	$191.40	$221.77
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $470.33 / $679.06 / $1,079.96	Professional	TC	$470.33	$679.06	$1,079.96
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $139.97 / $139.97 / $140.76	Facility	26	$139.97	$139.97	$140.76
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $544.88 / $818.11 / $1,043.64	Professional		$544.88	$818.11	$1,043.64
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $159.81 / $242.21 / $293.22	Professional	26	$159.81	$242.21	$293.22
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $385.08 / $588.41 / $753.50	Professional	TC	$385.08	$588.41	$753.50
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 $493.42 / $718.99 / $1,076.82	Professional		$493.42	$718.99	$1,076.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $142.76 / $213.14 / $287.87	Professional	26	$142.76	$213.14	$287.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $350.66 / $507.24 / $780.71	Professional	TC	$350.66	$507.24	$780.71
United Facility/Professional Professional Modifier Low / Median / High Price $337.13 / $573.44 / $1,152.78	Professional		$337.13	$573.44	$1,152.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.10 / $123.35 / $305.36	Professional	26	$95.10	$123.35	$305.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $242.03 / $497.06 / $893.68	Professional	TC	$242.03	$497.06	$893.68
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $389.72 / $389.72 / $389.72	Professional		$389.72	$389.72	$389.72
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $108.71 / $108.71 / $108.71	Professional	26	$108.71	$108.71	$108.71
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $281.01 / $281.01 / $281.01	Professional	TC	$281.01	$281.01	$281.01