Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.54 / $85.23 / $137.72	Facility	26	$53.54	$85.23	$137.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.60 / $248.00 / $446.77	Professional		$147.60	$248.00	$446.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.25 / $61.45 / $140.40	Professional	26	$46.25	$61.45	$140.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $130.12 / $206.54 / $308.00	Professional	TC	$130.12	$206.54	$308.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $127.54 / $257.81 / $400.00	Professional		$127.54	$257.81	$400.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.44 / $80.93 / $126.54	Professional	26	$50.44	$80.93	$126.54
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $442.24 / $442.24 / $442.24	Facility	26	$442.24	$442.24	$442.24
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $226.67 / $398.17 / $1,378.78	Professional		$226.67	$398.17	$1,378.78
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.14 / $116.69 / $388.43	Professional	26	$65.14	$116.69	$388.43
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $264.04 / $314.58 / $616.00	Professional	50	$264.04	$314.58	$616.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $169.55 / $301.29 / $1,103.98	Professional	TC	$169.55	$301.29	$1,103.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $178.29 / $341.34 / $573.75	Professional		$178.29	$341.34	$573.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.19 / $87.31 / $152.79	Professional	26	$47.19	$87.31	$152.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $127.74 / $247.97 / $421.75	Professional	TC	$127.74	$247.97	$421.75
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $52.65 / $106.57 / $319.91	Facility	26	$52.65	$106.57	$319.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $178.04 / $391.83 / $632.77	Professional		$178.04	$391.83	$632.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.24 / $100.70 / $132.47	Professional	26	$47.24	$100.70	$132.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $150.66 / $282.73 / $489.69	Professional	TC	$150.66	$282.73	$489.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.91 / $156.16 / $375.54	Professional		$29.91	$156.16	$375.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $76.95 / $92.51 / $95.88	Facility	26	$76.95	$92.51	$95.88
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $78.25 / $108.55	Professional		$78.25	$78.25	$108.55
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.89 / $87.00 / $103.20	Professional	26	$57.89	$87.00	$103.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $158.79 / $238.87 / $333.50	Professional	TC	$158.79	$238.87	$333.50
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $63.87 / $63.87 / $63.98	Facility	26	$63.87	$63.87	$63.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $259.30 / $390.55 / $472.19	Professional		$259.30	$390.55	$472.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.17 / $108.36 / $131.97	Professional	26	$72.17	$108.36	$131.97
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $187.13 / $280.31 / $338.91	Professional	TC	$187.13	$280.31	$338.91
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $234.70 / $343.23 / $469.75	Professional		$234.70	$343.23	$469.75
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.14 / $96.88 / $131.52	Professional	26	$65.14	$96.88	$131.52
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $169.55 / $246.35 / $335.69	Professional	TC	$169.55	$246.35	$335.69
United Facility/Professional Professional Modifier Low / Median / High Price $154.30 / $228.76 / $495.45	Professional		$154.30	$228.76	$495.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.56 / $56.80 / $140.34	Professional	26	$43.56	$56.80	$140.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $110.74 / $182.10 / $351.63	Professional	TC	$110.74	$182.10	$351.63
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $178.64 / $178.64 / $178.64	Professional		$178.64	$178.64	$178.64
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.05 / $49.05 / $49.05	Professional	26	$49.05	$49.05	$49.05
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $129.59 / $129.59 / $129.59	Professional	TC	$129.59	$129.59	$129.59