Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.40 / $119.17 / $208.98	Facility	26	$72.40	$119.17	$208.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $335.00 / $494.18 / $982.25	Professional		$335.00	$494.18	$982.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.41 / $140.00 / $205.06	Professional	26	$72.41	$140.00	$205.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $265.13 / $340.70 / $670.76	Professional	TC	$265.13	$340.70	$670.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $423.22 / $572.24 / $924.43	Professional		$423.22	$572.24	$924.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.60 / $102.88 / $116.59	Professional	26	$50.60	$102.88	$116.59
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $450.77 / $450.77 / $450.77	Professional	TC	$450.77	$450.77	$450.77
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $603.28 / $603.28	Facility	26	$446.45	$603.28	$603.28
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $434.49 / $793.61 / $2,819.97	Professional		$434.49	$793.61	$2,819.97
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $88.70 / $157.09 / $530.54	Professional	26	$88.70	$157.09	$530.54
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $357.13 / $654.17 / $2,495.53	Professional	TC	$357.13	$654.17	$2,495.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $335.84 / $655.91 / $1,093.69	Professional		$335.84	$655.91	$1,093.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.76 / $116.48 / $202.98	Professional	26	$63.76	$116.48	$202.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $273.49 / $540.45 / $895.48	Professional	TC	$273.49	$540.45	$895.48
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $71.06 / $145.38 / $698.97	Facility	26	$71.06	$145.38	$698.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $366.71 / $791.01 / $1,270.58	Professional		$366.71	$791.01	$1,270.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.93 / $135.91 / $176.64	Professional	26	$62.93	$135.91	$176.64
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $331.70 / $654.33 / $1,088.96	Professional	TC	$331.70	$654.33	$1,088.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.19 / $270.46 / $686.81	Professional		$61.19	$270.46	$686.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $102.82 / $126.07 / $129.97	Facility	26	$102.82	$126.07	$129.97
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $160.34 / $178.16	Professional		$160.34	$160.34	$178.16
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $77.18 / $115.20 / $136.77	Professional	26	$77.18	$115.20	$136.77
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $339.29 / $502.20 / $718.76	Professional	TC	$339.29	$502.20	$718.76
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $86.98 / $86.98 / $87.29	Facility	26	$86.98	$86.98	$87.29
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $492.30 / $737.79 / $898.00	Professional		$492.30	$737.79	$898.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $98.63 / $149.13 / $181.83	Professional	26	$98.63	$149.13	$181.83
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $393.33 / $587.40 / $731.08	Professional	TC	$393.33	$587.40	$731.08
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $782.93	Facility	26	$446.45	$446.45	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $445.83 / $648.40 / $955.57	Professional		$445.83	$648.40	$955.57
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $88.70 / $132.16 / $177.50	Professional	26	$88.70	$132.16	$177.50
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $357.13 / $516.60 / $765.77	Professional	TC	$357.13	$516.60	$765.77
United Facility/Professional Professional Modifier Low / Median / High Price $304.61 / $477.94 / $978.11	Professional		$304.61	$477.94	$978.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.90 / $73.62 / $189.12	Professional	26	$58.90	$73.62	$189.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.71 / $419.99 / $791.60	Professional	TC	$245.71	$419.99	$791.60
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $352.68 / $352.68 / $352.68	Professional		$352.68	$352.68	$352.68
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $66.93 / $66.93 / $66.93	Professional	26	$66.93	$66.93	$66.93
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $285.75 / $285.75 / $285.75	Professional	TC	$285.75	$285.75	$285.75