Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $262.35 / $700.68 / $1,309.32	Facility		$262.35	$700.68	$1,309.32
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.22 / $65.61 / $107.48	Facility	26	$48.22	$65.61	$107.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $174.93 / $248.16 / $527.55	Professional		$174.93	$248.16	$527.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.82 / $47.88 / $93.71	Professional	26	$30.82	$47.88	$93.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.80 / $204.52 / $395.03	Professional	TC	$151.80	$204.52	$395.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $141.97 / $295.32 / $357.96	Professional		$141.97	$295.32	$357.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.58 / $38.97 / $64.31	Professional	26	$36.58	$38.97	$64.31
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $377.77 / $695.98 / $938.39	Facility		$377.77	$695.98	$938.39
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $87.37 / $172.60 / $172.60	Facility	26	$87.37	$172.60	$172.60
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $251.79 / $453.20 / $1,570.58	Professional		$251.79	$453.20	$1,570.58
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.21 / $85.22 / $361.59	Professional	26	$52.21	$85.22	$361.59
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $199.91 / $356.50 / $1,274.61	Professional	TC	$199.91	$356.50	$1,274.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $475.81 / $831.68 / $1,144.41	Facility		$475.81	$831.68	$1,144.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $227.38 / $369.91 / $589.04	Professional		$227.38	$369.91	$589.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.07 / $66.37 / $119.31	Professional	26	$40.07	$66.37	$119.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $182.93 / $301.50 / $479.89	Professional	TC	$182.93	$301.50	$479.89
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $218.09 / $400.20 / $605.97	Facility		$218.09	$400.20	$605.97
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $35.27 / $72.75 / $132.54	Facility	26	$35.27	$72.75	$132.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $217.93 / $408.48 / $581.57	Professional		$217.93	$408.48	$581.57
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.26 / $72.75 / $98.61	Professional	26	$35.26	$72.75	$98.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $186.73 / $329.40 / $483.75	Professional	TC	$186.73	$329.40	$483.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.35 / $189.18 / $398.16	Professional		$35.35	$189.18	$398.16
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $295.72 / $352.72 / $424.11	Facility		$295.72	$352.72	$424.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $55.86 / $73.30 / $75.70	Facility	26	$55.86	$73.30	$75.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.57 / $56.48 / $82.49	Professional	26	$44.57	$56.48	$82.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $174.00 / $281.39 / $364.03	Professional	TC	$174.00	$281.39	$364.03
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $246.89 / $246.89 / $247.24	Facility		$246.89	$246.89	$247.24
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $51.18 / $51.18 / $51.19	Facility	26	$51.18	$51.18	$51.19
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $278.89 / $412.40 / $507.08	Professional		$278.89	$412.40	$507.08
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.74 / $85.38 / $104.98	Professional	26	$57.74	$85.38	$104.98
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $221.15 / $327.02 / $402.10	Professional	TC	$221.15	$327.02	$402.10
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $450.37 / $694.41 / $1,328.33	Facility		$450.37	$694.41	$1,328.33
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 $251.79 / $355.65 / $479.06	Professional		$251.79	$355.65	$479.06
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $52.21 / $73.63 / $99.18	Professional	26	$52.21	$73.63	$99.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $199.58 / $282.02 / $379.88	Professional	TC	$199.58	$282.02	$379.88
United Facility/Professional Professional Modifier Low / Median / High Price $207.48 / $328.32 / $524.03	Professional		$207.48	$328.32	$524.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.41 / $66.08 / $109.20	Professional	26	$41.41	$66.08	$109.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $172.20 / $280.70 / $431.59	Professional	TC	$172.20	$280.70	$431.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $205.95 / $205.95 / $205.95	Professional		$205.95	$205.95	$205.95
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.97 / $38.97 / $38.97	Professional	26	$38.97	$38.97	$38.97
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $166.97 / $166.97 / $166.97	Professional	TC	$166.97	$166.97	$166.97