Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $115.18 / $188.67 / $371.20	Facility	26	$115.18	$188.67	$371.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $402.08 / $534.32 / $1,267.58	Professional		$402.08	$534.32	$1,267.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $140.00 / $323.43	Professional	26	$104.00	$140.00	$323.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $322.33 / $419.13 / $916.08	Professional	TC	$322.33	$419.13	$916.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $304.49 / $736.63 / $1,174.75	Professional		$304.49	$736.63	$1,174.75
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $110.11 / $163.99 / $185.86	Professional	26	$110.11	$163.99	$185.86
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $953.92 / $953.92	Facility	26	$714.15	$953.92	$953.92
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $556.90 / $960.21 / $5,981.06	Professional		$556.90	$960.21	$5,981.06
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $139.52 / $240.65 / $883.52	Professional	26	$139.52	$240.65	$883.52
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $428.74 / $762.79 / $5,438.76	Professional	TC	$428.74	$762.79	$5,438.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $428.87 / $846.70 / $1,466.30	Professional		$428.87	$846.70	$1,466.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.97 / $184.10 / $320.91	Professional	26	$100.97	$184.10	$320.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $325.62 / $660.99 / $1,198.35	Professional	TC	$325.62	$660.99	$1,198.35
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $112.30 / $230.09 / $1,102.78	Facility	26	$112.30	$230.09	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $503.75 / $1,003.64 / $1,791.06	Professional		$503.75	$1,003.64	$1,791.06
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $99.51 / $214.78 / $279.54	Professional	26	$99.51	$214.78	$279.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $409.51 / $793.61 / $1,500.66	Professional	TC	$409.51	$793.61	$1,500.66
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 $166.10 / $200.75 / $205.69	Facility	26	$166.10	$200.75	$205.69
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $268.35 / $268.35	Professional		$268.35	$268.35	$268.35
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $122.61 / $182.71 / $219.60	Professional	26	$122.61	$182.71	$219.60
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $455.19 / $622.80 / $878.00	Professional	TC	$455.19	$622.80	$878.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $136.81 / $136.81 / $138.01	Facility	26	$136.81	$136.81	$138.01
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $625.29 / $937.01 / $1,196.19	Professional		$625.29	$937.01	$1,196.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $156.16 / $237.49 / $287.50	Professional	26	$156.16	$237.49	$287.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $468.59 / $703.24 / $892.62	Professional	TC	$468.59	$703.24	$892.62
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 $568.26 / $823.48 / $1,221.53	Professional		$568.26	$823.48	$1,221.53
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $139.52 / $208.98 / $280.51	Professional	26	$139.52	$208.98	$280.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $428.74 / $620.17 / $911.53	Professional	TC	$428.74	$620.17	$911.53
United Facility/Professional Professional Modifier Low / Median / High Price $389.59 / $660.40 / $1,250.96	Professional		$389.59	$660.40	$1,250.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.20 / $115.20 / $300.42	Professional	26	$93.20	$115.20	$300.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $296.33 / $584.24 / $1,026.24	Professional	TC	$296.33	$584.24	$1,026.24
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $446.44 / $446.44 / $446.44	Professional		$446.44	$446.44	$446.44
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 $339.81 / $339.81 / $339.81	Professional	TC	$339.81	$339.81	$339.81