Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $122.75 / $201.04 / $357.05	Facility	26	$122.75	$201.04	$357.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.46 / $509.25 / $1,022.33	Professional		$400.46	$509.25	$1,022.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.81 / $154.00 / $344.64	Professional	26	$106.81	$154.00	$344.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $270.86 / $344.22 / $677.69	Professional	TC	$270.86	$344.22	$677.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $255.37 / $610.75 / $955.64	Professional		$255.37	$610.75	$955.64
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $86.65 / $181.76 / $289.98	Professional	26	$86.65	$181.76	$289.98
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,016.96 / $1,016.96 / $1,016.96	Facility	26	$1,016.96	$1,016.96	$1,016.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $465.70 / $795.68 / $6,195.24	Professional		$465.70	$795.68	$6,195.24
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $148.76 / $260.52 / $931.20	Professional	26	$148.76	$260.52	$931.20
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $316.93 / $571.77 / $5,551.18	Professional	TC	$316.93	$571.77	$5,551.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $354.19 / $706.52 / $1,254.26	Professional		$354.19	$706.52	$1,254.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.99 / $198.24 / $354.36	Professional	26	$107.99	$198.24	$354.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $245.27 / $488.53 / $935.67	Professional	TC	$245.27	$488.53	$935.67
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $119.66 / $248.72 / $1,102.78	Facility	26	$119.66	$248.72	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $452.49 / $831.88 / $1,724.52	Professional		$452.49	$831.88	$1,724.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $113.15 / $240.50 / $313.04	Professional	26	$113.15	$240.50	$313.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $323.39 / $596.82 / $1,439.10	Professional	TC	$323.39	$596.82	$1,439.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $57.59 / $274.36 / $658.21	Professional		$57.59	$274.36	$658.21
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $177.10 / $213.86 / $219.09	Facility	26	$177.10	$213.86	$219.09
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $131.05 / $190.13 / $238.88	Professional	26	$131.05	$190.13	$238.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $301.60 / $447.45 / $736.65	Professional	TC	$301.60	$447.45	$736.65
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $145.87 / $145.87 / $147.15	Facility	26	$145.87	$145.87	$147.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $517.04 / $778.74 / $983.74	Professional		$517.04	$778.74	$983.74
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $167.02 / $253.22 / $306.54	Professional	26	$167.02	$253.22	$306.54
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $350.02 / $525.20 / $670.47	Professional	TC	$350.02	$525.20	$670.47
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 $465.70 / $684.39 / $992.36	Professional		$465.70	$684.39	$992.36
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $148.76 / $222.82 / $298.89	Professional	26	$148.76	$222.82	$298.89
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $316.93 / $461.56 / $693.45	Professional	TC	$316.93	$461.56	$693.45
United Facility/Professional Professional Modifier Low / Median / High Price $318.11 / $536.77 / $1,057.17	Professional		$318.11	$536.77	$1,057.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $99.70 / $130.00 / $321.18	Professional	26	$99.70	$130.00	$321.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $218.41 / $436.83 / $846.01	Professional	TC	$218.41	$436.83	$846.01
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $370.15 / $370.15 / $370.15	Professional		$370.15	$370.15	$370.15
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $113.60 / $113.60 / $113.60	Professional	26	$113.60	$113.60	$113.60
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $256.55 / $256.55 / $256.55	Professional	TC	$256.55	$256.55	$256.55