Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.45 / $182.82 / $301.49	Facility	26	$116.45	$182.82	$301.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $371.00 / $541.83 / $1,025.21	Professional		$371.00	$541.83	$1,025.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.00 / $124.15 / $306.00	Professional	26	$86.00	$124.15	$306.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $285.00 / $447.91 / $727.45	Professional	TC	$285.00	$447.91	$727.45
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $302.31 / $721.02 / $721.02	Professional		$302.31	$721.02	$721.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $161.50 / $178.53 / $201.88	Professional	26	$161.50	$178.53	$201.88
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $969.20 / $969.20	Facility	26	$714.15	$969.20	$969.20
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $535.15 / $941.76 / $3,372.90	Professional		$535.15	$941.76	$3,372.90
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $141.83 / $248.49 / $852.90	Professional	26	$141.83	$248.49	$852.90
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $409.33 / $736.07 / $2,520.00	Professional	TC	$409.33	$736.07	$2,520.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $400.14 / $766.95 / $1,318.99	Professional		$400.14	$766.95	$1,318.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.07 / $189.29 / $325.97	Professional	26	$103.07	$189.29	$325.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $287.20 / $601.55 / $977.65	Professional	TC	$287.20	$601.55	$977.65
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $101.69 / $234.22 / $1,002.46	Facility	26	$101.69	$234.22	$1,002.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $465.93 / $867.42 / $1,470.12	Professional		$465.93	$867.42	$1,470.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $101.69 / $218.30 / $283.83	Professional	26	$101.69	$218.30	$283.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $337.82 / $643.67 / $1,197.61	Professional	TC	$337.82	$643.67	$1,197.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.67 / $330.19 / $823.24	Professional		$75.67	$330.19	$823.24
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $168.85 / $203.87 / $209.71	Facility	26	$168.85	$203.87	$209.71
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $268.35 / $268.35	Professional		$268.35	$268.35	$268.35
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $135.08 / $185.12 / $223.20	Professional	26	$135.08	$185.12	$223.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $357.96 / $507.29 / $694.83	Professional	TC	$357.96	$507.29	$694.83
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $139.07 / $139.07 / $140.30	Facility	26	$139.07	$139.07	$140.30
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $611.38 / $922.05 / $1,114.79	Professional		$611.38	$922.05	$1,114.79
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $158.72 / $240.96 / $287.75	Professional	26	$158.72	$240.96	$287.75
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $452.09 / $680.31 / $834.91	Professional	TC	$452.09	$680.31	$834.91
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $851.78	Facility	26	$714.15	$714.15	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $551.16 / $810.33 / $1,123.45	Professional		$551.16	$810.33	$1,123.45
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $141.83 / $212.44 / $285.11	Professional	26	$141.83	$212.44	$285.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $409.33 / $597.89 / $834.35	Professional	TC	$409.33	$597.89	$834.35
United Facility/Professional Professional Modifier Low / Median / High Price $349.71 / $506.45 / $1,126.69	Professional		$349.71	$506.45	$1,126.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.10 / $123.36 / $296.48	Professional	26	$95.10	$123.36	$296.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $254.61 / $411.41 / $924.36	Professional	TC	$254.61	$411.41	$924.36
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $441.97 / $441.97 / $441.97	Professional		$441.97	$441.97	$441.97
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $108.20 / $108.20 / $108.20	Professional	26	$108.20	$108.20	$108.20
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $333.77 / $333.77 / $333.77	Professional	TC	$333.77	$333.77	$333.77