Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.45 / $184.39 / $348.03	Facility	26	$117.45	$184.39	$348.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.00 / $522.50 / $1,336.26	Professional		$400.00	$522.50	$1,336.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $154.00 / $390.39	Professional	26	$104.00	$154.00	$390.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.41 / $353.36 / $828.53	Professional	TC	$281.41	$353.36	$828.53
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $341.67 / $645.65 / $1,016.39	Professional		$341.67	$645.65	$1,016.39
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $82.83 / $179.37 / $277.52	Professional	26	$82.83	$179.37	$277.52
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $445.79 / $445.79 / $522.79	Professional	TC	$445.79	$445.79	$522.79
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $973.04 / $973.04	Facility	26	$714.15	$973.04	$973.04
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $494.34 / $841.69 / $6,025.38	Professional		$494.34	$841.69	$6,025.38
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $142.30 / $248.62 / $891.52	Professional	26	$142.30	$248.62	$891.52
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $352.04 / $634.60 / $5,457.89	Professional	TC	$352.04	$634.60	$5,457.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $382.15 / $754.02 / $1,364.49	Professional		$382.15	$754.02	$1,364.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.98 / $189.85 / $327.32	Professional	26	$102.98	$189.85	$327.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $273.95 / $587.99 / $1,055.21	Professional	TC	$273.95	$587.99	$1,055.21
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $115.24 / $235.03 / $1,102.78	Facility	26	$115.24	$235.03	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $509.14 / $932.90 / $1,834.05	Professional		$509.14	$932.90	$1,834.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $102.30 / $220.46 / $285.54	Professional	26	$102.30	$220.46	$285.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $384.93 / $694.12 / $1,583.80	Professional	TC	$384.93	$694.12	$1,583.80
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 $169.40 / $204.76 / $216.41	Facility	26	$169.40	$204.76	$216.41
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $241.83 / $241.83 / $479.56	Professional		$241.83	$241.83	$479.56
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $128.24 / $184.80 / $223.98	Professional	26	$128.24	$184.80	$223.98
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $365.76 / $589.29 / $1,212.90	Professional	TC	$365.76	$589.29	$1,212.90
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $139.52 / $139.52 / $140.76	Facility	26	$139.52	$139.52	$140.76
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $546.95 / $821.26 / $1,045.51	Professional		$546.95	$821.26	$1,045.51
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $159.25 / $242.21 / $293.22	Professional	26	$159.25	$242.21	$293.22
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $387.14 / $591.55 / $755.41	Professional	TC	$387.14	$591.55	$755.41
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 $494.34 / $721.76 / $1,079.03	Professional		$494.34	$721.76	$1,079.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $142.30 / $213.14 / $287.87	Professional	26	$142.30	$213.14	$287.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $352.04 / $509.24 / $784.98	Professional	TC	$352.04	$509.24	$784.98
United Facility/Professional Professional Modifier Low / Median / High Price $337.75 / $642.82 / $1,152.78	Professional		$337.75	$642.82	$1,152.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.10 / $123.04 / $301.97	Professional	26	$95.10	$123.04	$301.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $242.65 / $481.72 / $894.08	Professional	TC	$242.65	$481.72	$894.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $391.30 / $391.30 / $391.30	Professional		$391.30	$391.30	$391.30
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $108.71 / $108.71 / $108.71	Professional	26	$108.71	$108.71	$108.71
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $282.58 / $282.58 / $282.58	Professional	TC	$282.58	$282.58	$282.58