Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.72 / $153.26 / $280.62	Facility	26	$87.72	$153.26	$280.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.50 / $494.18 / $1,153.24	Professional		$370.50	$494.18	$1,153.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.00 / $140.00 / $246.35	Professional	26	$85.00	$140.00	$246.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $282.87 / $348.17 / $758.82	Professional	TC	$282.87	$348.17	$758.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $247.42 / $592.96 / $900.00	Professional		$247.42	$592.96	$900.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.44 / $119.63 / $139.82	Professional	26	$42.44	$119.63	$139.82
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $720.40 / $720.40 / $720.40	Facility	26	$720.40	$720.40	$720.40
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $458.36 / $780.61 / $3,348.15	Professional		$458.36	$780.61	$3,348.15
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $106.72 / $190.11 / $632.63	Professional	26	$106.72	$190.11	$632.63
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $354.82 / $631.24 / $2,941.88	Professional	TC	$354.82	$631.24	$2,941.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $349.04 / $690.26 / $1,142.85	Professional		$349.04	$690.26	$1,142.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.75 / $140.06 / $242.36	Professional	26	$76.75	$140.06	$242.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $271.27 / $540.54 / $889.85	Professional	TC	$271.27	$540.54	$889.85
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $95.12 / $174.34 / $2,217.21	Facility	26	$95.12	$174.34	$2,217.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $412.92 / $816.61 / $1,342.12	Professional		$412.92	$816.61	$1,342.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $85.42 / $170.59 / $211.80	Professional	26	$85.42	$170.59	$211.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $341.00 / $657.39 / $1,121.88	Professional	TC	$341.00	$657.39	$1,121.88
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 $125.40 / $151.19 / $156.11	Facility	26	$125.40	$151.19	$156.11
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $397.94 / $409.50 / $409.50	Professional		$397.94	$409.50	$409.50
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $93.26 / $132.69 / $175.56	Professional	26	$93.26	$132.69	$175.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $354.48 / $508.56 / $690.85	Professional	TC	$354.48	$508.56	$690.85
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $104.20 / $104.20 / $104.64	Facility	26	$104.20	$104.20	$104.64
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $507.25 / $762.20 / $936.57	Professional		$507.25	$762.20	$936.57
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $118.57 / $179.30 / $217.06	Professional	26	$118.57	$179.30	$217.06
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $388.69 / $584.25 / $743.85	Professional	TC	$388.69	$584.25	$743.85
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,387.45 / $1,387.45 / $2,298.07	Facility	26	$1,387.45	$1,387.45	$2,298.07
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $461.54 / $669.86 / $993.65	Professional		$461.54	$669.86	$993.65
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $106.72 / $157.78 / $213.37	Professional	26	$106.72	$157.78	$213.37
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $354.82 / $513.25 / $759.61	Professional	TC	$354.82	$513.25	$759.61
United Facility/Professional Professional Modifier Low / Median / High Price $316.27 / $456.03 / $1,004.26	Professional		$316.27	$456.03	$1,004.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.17 / $91.03 / $228.53	Professional	26	$71.17	$91.03	$228.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.10 / $433.18 / $789.60	Professional	TC	$245.10	$433.18	$789.60
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $364.43 / $364.43 / $364.43	Professional		$364.43	$364.43	$364.43
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Professional	26	$80.26	$80.26	$80.26
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $284.17 / $284.17 / $284.17	Professional	TC	$284.17	$284.17	$284.17