Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $71.98 / $118.53 / $207.89	Facility	26	$71.98	$118.53	$207.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $303.70 / $475.00 / $982.25	Professional		$303.70	$475.00	$982.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.98 / $140.00 / $254.90	Professional	26	$71.98	$140.00	$254.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $712.50 / $712.50 / $712.50	Professional	50	$712.50	$712.50	$712.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $231.73 / $335.00 / $596.05	Professional	TC	$231.73	$335.00	$596.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $310.18 / $426.49 / $516.96	Professional		$310.18	$426.49	$516.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.34 / $102.33 / $123.10	Professional	26	$50.34	$102.33	$123.10
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $596.96 / $596.96	Facility	26	$446.45	$596.96	$596.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $325.70 / $561.40 / $2,789.74	Professional		$325.70	$561.40	$2,789.74
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.78 / $150.80 / $531.65	Professional	26	$87.78	$150.80	$531.65
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $404.29 / $494.83 / $1,234.68	Professional	50	$404.29	$494.83	$1,234.68
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $245.80 / $453.55 / $2,459.04	Professional	TC	$245.80	$453.55	$2,459.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $252.49 / $537.09 / $874.97	Professional		$252.49	$537.09	$874.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.39 / $116.36 / $200.79	Professional	26	$63.39	$116.36	$200.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.06 / $414.38 / $705.63	Professional	TC	$186.06	$414.38	$705.63
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $71.06 / $144.68 / $698.97	Facility	26	$71.06	$144.68	$698.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $350.14 / $620.79 / $1,220.65	Professional		$350.14	$620.79	$1,220.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.93 / $135.91 / $175.37	Professional	26	$62.93	$135.91	$175.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $290.27 / $509.76 / $1,066.73	Professional	TC	$290.27	$509.76	$1,066.73
Molina Facility/Professional Professional Modifier Low / Median / High Price $42.62 / $240.98 / $487.78	Professional		$42.62	$240.98	$487.78
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $102.29 / $125.41 / $129.31	Facility	26	$102.29	$125.41	$129.31
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $160.34 / $183.23	Professional		$160.34	$160.34	$183.23
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $76.78 / $115.80 / $143.72	Professional	26	$76.78	$115.80	$143.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $288.64 / $493.74 / $824.85	Professional	TC	$288.64	$493.74	$824.85
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $86.07 / $86.07 / $86.37	Facility	26	$86.07	$86.07	$86.37
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $360.85 / $551.39 / $687.96	Professional		$360.85	$551.39	$687.96
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $98.12 / $148.35 / $177.15	Professional	26	$98.12	$148.35	$177.15
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $262.39 / $400.94 / $509.97	Professional	TC	$262.39	$400.94	$509.97
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 $325.70 / $476.79 / $716.99	Professional		$325.70	$476.79	$716.99
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $87.78 / $130.79 / $177.50	Professional	26	$87.78	$130.79	$177.50
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $237.93 / $346.00 / $534.00	Professional	TC	$237.93	$346.00	$534.00
United Facility/Professional Professional Modifier Low / Median / High Price $222.40 / $448.05 / $737.80	Professional		$222.40	$448.05	$737.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.59 / $85.00 / $186.05	Professional	26	$58.59	$85.00	$186.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $163.81 / $315.85 / $584.61	Professional	TC	$163.81	$315.85	$584.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $258.48 / $258.48 / $258.48	Professional		$258.48	$258.48	$258.48
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $66.54 / $66.54 / $66.54	Professional	26	$66.54	$66.54	$66.54
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $191.95 / $191.95 / $191.95	Professional	TC	$191.95	$191.95	$191.95