Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.75 / $155.32 / $310.76	Facility	26	$78.75	$155.32	$310.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.77 / $494.18 / $1,036.33	Professional		$400.77	$494.18	$1,036.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.75 / $140.00 / $231.92	Professional	26	$78.75	$140.00	$231.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $290.68 / $364.87 / $813.18	Professional	TC	$290.68	$364.87	$813.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $627.07 / $627.07 / $627.07	Professional		$627.07	$627.07	$627.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.63 / $120.09 / $145.31	Professional	26	$38.63	$120.09	$145.31
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $656.72 / $656.72 / $656.72	Facility	26	$656.72	$656.72	$656.72
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $477.25 / $825.26 / $5,311.18	Professional		$477.25	$825.26	$5,311.18
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $96.56 / $171.20 / $808.00	Professional	26	$96.56	$171.20	$808.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $380.69 / $688.23 / $4,858.99	Professional	TC	$380.69	$688.23	$4,858.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $372.47 / $833.73 / $1,429.01	Professional		$372.47	$833.73	$1,429.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.84 / $131.47 / $228.78	Professional	26	$70.84	$131.47	$228.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $300.30 / $691.49 / $1,285.64	Professional	TC	$300.30	$691.49	$1,285.64
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $81.34 / $169.51 / $1,102.78	Facility	26	$81.34	$169.51	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $549.49 / $1,001.95 / $2,075.85	Professional		$549.49	$1,001.95	$2,075.85
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $79.05 / $157.36 / $216.94	Professional	26	$79.05	$157.36	$216.94
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $488.56 / $847.21 / $1,851.96	Professional	TC	$488.56	$847.21	$1,851.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $64.24 / $286.44 / $724.73	Professional		$64.24	$286.44	$724.73
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $114.32 / $137.19 / $172.19	Facility	26	$114.32	$137.19	$172.19
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $99.23 / $146.49 / $172.19	Professional	26	$99.23	$146.49	$172.19
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $489.04 / $816.24 / $1,493.58	Professional	TC	$489.04	$816.24	$1,493.58
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $94.68 / $94.68 / $95.06	Facility	26	$94.68	$94.68	$95.06
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $530.45 / $810.54 / $998.71	Professional		$530.45	$810.54	$998.71
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $107.74 / $162.58 / $194.96	Professional	26	$107.74	$162.58	$194.96
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $422.71 / $637.79 / $797.43	Professional	TC	$422.71	$637.79	$797.43
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 $477.25 / $704.46 / $1,087.22	Professional		$477.25	$704.46	$1,087.22
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $96.56 / $143.94 / $195.19	Professional	26	$96.56	$143.94	$195.19
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $380.69 / $560.52 / $865.08	Professional	TC	$380.69	$560.52	$865.08
United Facility/Professional Professional Modifier Low / Median / High Price $320.88 / $673.20 / $1,181.83	Professional		$320.88	$673.20	$1,181.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.73 / $88.12 / $207.84	Professional	26	$64.73	$88.12	$207.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $256.14 / $525.17 / $941.80	Professional	TC	$256.14	$525.17	$941.80
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $386.43 / $386.43 / $386.43	Professional		$386.43	$386.43	$386.43
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $72.78 / $72.78 / $72.78	Professional	26	$72.78	$72.78	$72.78
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $313.64 / $313.64 / $313.64	Professional	TC	$313.64	$313.64	$313.64