Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $115.18 / $189.70 / $371.20	Facility	26	$115.18	$189.70	$371.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $422.31 / $568.87 / $1,320.50	Professional		$422.31	$568.87	$1,320.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $140.00 / $324.42	Professional	26	$104.00	$140.00	$324.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $453.68 / $1,020.25	Professional	TC	$335.00	$453.68	$1,020.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $324.32 / $684.14 / $775.36	Professional		$324.32	$684.14	$775.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.98 / $163.99 / $197.27	Professional	26	$43.98	$163.99	$197.27
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $683.93 / $683.93 / $683.93	Professional	TC	$683.93	$683.93	$683.93
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $953.92 / $953.92 / $953.92	Facility	26	$953.92	$953.92	$953.92
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $591.01 / $1,022.56 / $5,981.06	Professional		$591.01	$1,022.56	$5,981.06
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $139.99 / $249.37 / $838.35	Professional	26	$139.99	$249.37	$838.35
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $463.39 / $826.71 / $5,438.76	Professional	TC	$463.39	$826.71	$5,438.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $456.89 / $895.26 / $1,560.88	Professional		$456.89	$895.26	$1,560.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.97 / $184.71 / $320.91	Professional	26	$100.97	$184.71	$320.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $353.16 / $708.98 / $1,271.70	Professional	TC	$353.16	$708.98	$1,271.70
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $112.66 / $230.09 / $1,102.78	Facility	26	$112.66	$230.09	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $534.75 / $1,068.58 / $1,876.66	Professional		$534.75	$1,068.58	$1,876.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $100.13 / $215.48 / $279.54	Professional	26	$100.13	$215.48	$279.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $440.51 / $858.66 / $1,583.80	Professional	TC	$440.51	$858.66	$1,583.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $81.43 / $359.36 / $905.68	Professional		$81.43	$359.36	$905.68
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $154.84 / $200.75 / $205.69	Facility	26	$154.84	$200.75	$205.69
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $457.29 / $487.84	Professional		$268.35	$457.29	$487.84
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $122.80 / $180.12 / $216.44	Professional	26	$122.80	$180.12	$216.44
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $458.28 / $672.60 / $1,084.59	Professional	TC	$458.28	$672.60	$1,084.59
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $137.26 / $137.26 / $138.01	Facility	26	$137.26	$137.26	$138.01
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $664.48 / $996.06 / $1,271.58	Professional		$664.48	$996.06	$1,271.58
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $156.71 / $233.75 / $283.61	Professional	26	$156.71	$233.75	$283.61
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $507.77 / $761.66 / $968.01	Professional	TC	$507.77	$761.66	$968.01
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 $603.37 / $875.38 / $1,298.52	Professional		$603.37	$875.38	$1,298.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $139.99 / $208.98 / $281.43	Professional	26	$139.99	$208.98	$281.43
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $463.39 / $670.30 / $988.52	Professional	TC	$463.39	$670.30	$988.52
United Facility/Professional Professional Modifier Low / Median / High Price $413.52 / $620.09 / $1,313.06	Professional		$413.52	$620.09	$1,313.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.26 / $120.64 / $296.11	Professional	26	$93.26	$120.64	$296.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $320.26 / $654.84 / $1,122.00	Professional	TC	$320.26	$654.84	$1,122.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $476.31 / $476.31 / $476.31	Professional		$476.31	$476.31	$476.31
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $106.63 / $106.63 / $106.63	Professional	26	$106.63	$106.63	$106.63
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $369.69 / $369.69 / $369.69	Professional	TC	$369.69	$369.69	$369.69