Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $115.60 / $190.35 / $372.55	Facility	26	$115.60	$190.35	$372.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $402.08 / $536.02 / $1,243.47	Professional		$402.08	$536.02	$1,243.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $142.38 / $324.42	Professional	26	$104.00	$142.38	$324.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $323.39 / $420.41 / $931.29	Professional	TC	$323.39	$420.41	$931.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $305.27 / $729.58 / $729.58	Professional		$305.27	$729.58	$729.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $159.02 / $185.86 / $197.27	Professional	26	$159.02	$185.86	$197.27
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $957.12 / $957.12	Facility	26	$714.15	$957.12	$957.12
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $559.00 / $963.38 / $5,981.06	Professional		$559.00	$963.38	$5,981.06
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $139.99 / $250.19 / $894.00	Professional	26	$139.99	$250.19	$894.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $430.12 / $765.44 / $5,438.76	Professional	TC	$430.12	$765.44	$5,438.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $429.96 / $844.20 / $1,471.28	Professional		$429.96	$844.20	$1,471.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.97 / $184.71 / $322.01	Professional	26	$100.97	$184.71	$322.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $327.08 / $657.77 / $1,200.78	Professional	TC	$327.08	$657.77	$1,200.78
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $112.66 / $231.19 / $1,102.78	Facility	26	$112.66	$231.19	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $504.06 / $1,006.77 / $1,794.35	Professional		$504.06	$1,006.77	$1,794.35
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $100.13 / $215.48 / $281.26	Professional	26	$100.13	$215.48	$281.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $409.82 / $794.38 / $1,505.45	Professional	TC	$409.82	$794.38	$1,505.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $80.78 / $350.76 / $856.45	Professional		$80.78	$350.76	$856.45
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $166.65 / $200.75 / $206.36	Facility	26	$166.65	$200.75	$206.36
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $268.35 / $298.17	Professional		$268.35	$268.35	$298.17
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $123.20 / $179.55 / $229.52	Professional	26	$123.20	$179.55	$229.52
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $410.80 / $598.36 / $958.93	Professional	TC	$410.80	$598.36	$958.93
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $137.26 / $137.26 / $138.47	Facility	26	$137.26	$137.26	$138.47
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $627.36 / $940.94 / $1,201.21	Professional		$627.36	$940.94	$1,201.21
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $156.68 / $234.52 / $284.54	Professional	26	$156.68	$234.52	$284.54
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $470.14 / $705.38 / $896.64	Professional	TC	$470.14	$705.38	$896.64
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 $570.11 / $826.94 / $1,225.96	Professional		$570.11	$826.94	$1,225.96
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $139.99 / $209.68 / $281.43	Professional	26	$139.99	$209.68	$281.43
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $430.12 / $622.19 / $915.64	Professional	TC	$430.12	$622.19	$915.64
United Facility/Professional Professional Modifier Low / Median / High Price $390.20 / $686.88 / $1,257.06	Professional		$390.20	$686.88	$1,257.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.25 / $122.80 / $309.44	Professional	26	$93.25	$122.80	$309.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $296.95 / $516.51 / $1,047.45	Professional	TC	$296.95	$516.51	$1,047.45
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $447.62 / $447.62 / $447.62	Professional		$447.62	$447.62	$447.62
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 $341.00 / $341.00 / $341.00	Professional	TC	$341.00	$341.00	$341.00