Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.01 / $153.94 / $251.51	Facility	26	$78.01	$153.94	$251.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $357.91 / $494.18 / $890.16	Professional		$357.91	$494.18	$890.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.01 / $140.00 / $251.51	Professional	26	$78.01	$140.00	$251.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $279.89 / $348.53 / $670.24	Professional	TC	$279.89	$348.53	$670.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,032.94 / $1,032.94 / $1,032.94	Professional		$1,032.94	$1,032.94	$1,032.94
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.67 / $54.67 / $113.98	Professional	26	$54.67	$54.67	$113.98
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $647.12 / $647.12 / $647.12	Facility	26	$647.12	$647.12	$647.12
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $476.65 / $882.29 / $3,077.22	Professional		$476.65	$882.29	$3,077.22
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.17 / $164.21 / $680.25	Professional	26	$95.17	$164.21	$680.25
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $402.86 / $713.48 / $2,677.57	Professional	TC	$402.86	$713.48	$2,677.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $377.06 / $742.79 / $1,217.89	Professional		$377.06	$742.79	$1,217.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.84 / $125.57 / $217.70	Professional	26	$68.84	$125.57	$217.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $307.27 / $612.74 / $992.47	Professional	TC	$307.27	$612.74	$992.47
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $76.58 / $156.68 / $698.97	Facility	26	$76.58	$156.68	$698.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $415.53 / $880.93 / $1,415.15	Professional		$415.53	$880.93	$1,415.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.89 / $146.47 / $190.13	Professional	26	$67.89	$146.47	$190.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $375.72 / $748.46 / $1,189.36	Professional	TC	$375.72	$748.46	$1,189.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.19 / $270.46 / $686.81	Professional		$61.19	$270.46	$686.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $104.37 / $135.85 / $139.36	Facility	26	$104.37	$135.85	$139.36
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $295.44 / $295.44 / $295.44	Professional		$295.44	$295.44	$295.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $83.62 / $123.54 / $154.38	Professional	26	$83.62	$123.54	$154.38
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $387.53 / $616.96 / $796.77	Professional	TC	$387.53	$616.96	$796.77
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $93.32 / $93.32 / $93.69	Facility	26	$93.32	$93.32	$93.69
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $547.98 / $821.26 / $1,003.38	Professional		$547.98	$821.26	$1,003.38
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $106.34 / $160.90 / $192.15	Professional	26	$106.34	$160.90	$192.15
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $441.27 / $661.20 / $821.84	Professional	TC	$441.27	$661.20	$821.84
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 $498.04 / $721.76 / $1,070.64	Professional		$498.04	$721.76	$1,070.64
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.17 / $141.86 / $191.30	Professional	26	$95.17	$141.86	$191.30
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $402.86 / $582.76 / $860.21	Professional	TC	$402.86	$582.76	$860.21
United Facility/Professional Professional Modifier Low / Median / High Price $342.35 / $478.25 / $1,087.07	Professional		$342.35	$478.25	$1,087.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.81 / $78.83 / $202.62	Professional	26	$63.81	$78.83	$202.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $278.54 / $458.92 / $897.32	Professional	TC	$278.54	$458.92	$897.32
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $366.93 / $366.93 / $366.93	Professional		$366.93	$366.93	$366.93
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $72.09 / $72.09 / $72.09	Professional	26	$72.09	$72.09	$72.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $294.83 / $294.83 / $294.83	Professional	TC	$294.83	$294.83	$294.83