Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.20 / $132.13 / $276.75	Facility	26	$107.20	$132.13	$276.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $365.76 / $454.07 / $976.63	Professional		$365.76	$454.07	$976.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.53 / $113.89 / $269.57	Professional	26	$84.53	$113.89	$269.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $278.01 / $344.44 / $670.83	Professional	TC	$278.01	$344.44	$670.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $268.44 / $648.48 / $727.09	Professional		$268.44	$648.48	$727.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $73.83 / $163.32 / $253.31	Professional	26	$73.83	$163.32	$253.31
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $463.85 / $463.85 / $470.46	Professional	TC	$463.85	$463.85	$470.46
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $887.84 / $887.84	Facility	26	$714.15	$887.84	$887.84
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $478.94 / $856.09 / $3,015.98	Professional		$478.94	$856.09	$3,015.98
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $130.28 / $227.94 / $779.55	Professional	26	$130.28	$227.94	$779.55
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $367.75 / $619.82 / $2,909.00	Professional	TC	$367.75	$619.82	$2,909.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $350.84 / $663.40 / $1,138.88	Professional		$350.84	$663.40	$1,138.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $94.36 / $174.00 / $309.33	Professional	26	$94.36	$174.00	$309.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $251.73 / $501.93 / $882.63	Professional	TC	$251.73	$501.93	$882.63
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $116.85 / $216.84 / $1,102.78	Facility	26	$116.85	$216.84	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $376.34 / $769.89 / $1,143.96	Professional		$376.34	$769.89	$1,143.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.93 / $206.62 / $260.68	Professional	26	$104.93	$206.62	$260.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $287.99 / $552.54 / $885.00	Professional	TC	$287.99	$552.54	$885.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $66.21 / $300.95 / $745.03	Professional		$66.21	$300.95	$745.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $154.55 / $186.54 / $192.29	Facility	26	$154.55	$186.54	$192.29
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 $114.97 / $165.88 / $199.19	Professional	26	$114.97	$165.88	$199.19
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $324.22 / $459.02 / $550.79	Professional	TC	$324.22	$459.02	$550.79
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $127.75 / $127.75 / $128.41	Facility	26	$127.75	$127.75	$128.41
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $549.52 / $825.20 / $997.70	Professional		$549.52	$825.20	$997.70
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $145.88 / $220.98 / $263.95	Professional	26	$145.88	$220.98	$263.95
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $403.64 / $603.94 / $730.18	Professional	TC	$403.64	$603.94	$730.18
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $851.78	Facility	26	$714.15	$714.15	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $498.04 / $725.22 / $972.29	Professional		$498.04	$725.22	$972.29
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $130.28 / $194.45 / $262.11	Professional	26	$130.28	$194.45	$262.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $367.75 / $531.97 / $739.00	Professional	TC	$367.75	$531.97	$739.00
United Facility/Professional Professional Modifier Low / Median / High Price $317.50 / $418.62 / $1,012.71	Professional		$317.50	$418.62	$1,012.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.12 / $115.00 / $273.48	Professional	26	$87.12	$115.00	$273.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $230.38 / $389.15 / $794.36	Professional	TC	$230.38	$389.15	$794.36
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $393.02 / $393.02 / $393.02	Professional		$393.02	$393.02	$393.02
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $98.98 / $98.98 / $98.98	Professional	26	$98.98	$98.98	$98.98
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $294.04 / $294.04 / $294.04	Professional	TC	$294.04	$294.04	$294.04