Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.50 / $252.53 / $415.80	Facility	26	$128.50	$252.53	$415.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $227.87 / $307.06 / $515.91	Professional		$227.87	$307.06	$515.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.00 / $128.50 / $253.59	Professional	26	$86.00	$128.50	$253.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $190.35 / $285.00	Professional	TC	$119.70	$190.35	$285.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $326.14 / $365.34 / $365.34	Professional		$326.14	$365.34	$365.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $182.85 / $182.85 / $182.85	Professional	26	$182.85	$182.85	$182.85
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $1,061.59 / $1,061.59	Facility	26	$211.40	$1,061.59	$1,061.59
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $501.21 / $1,058.99 / $1,915.39	Professional		$501.21	$1,058.99	$1,915.39
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $155.69 / $268.49 / $932.25	Professional	26	$155.69	$268.49	$932.25
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $314.02 / $761.69 / $1,435.54	Professional	TC	$314.02	$761.69	$1,435.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $443.91 / $839.01 / $1,387.02	Professional		$443.91	$839.01	$1,387.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.59 / $205.18 / $357.07	Professional	26	$112.59	$205.18	$357.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $330.71 / $634.29 / $1,073.20	Professional	TC	$330.71	$634.29	$1,073.20
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $111.60 / $241.44 / $341.25	Facility	26	$111.60	$241.44	$341.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $478.95 / $920.58 / $1,278.48	Professional		$478.95	$920.58	$1,278.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $111.60 / $235.02 / $312.13	Professional	26	$111.60	$235.02	$312.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $370.78 / $687.40 / $980.58	Professional	TC	$370.78	$687.40	$980.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.22 / $188.61 / $423.57	Professional		$34.22	$188.61	$423.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $184.80 / $223.87 / $229.84	Facility	26	$184.80	$223.87	$229.84
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $78.25 / $78.25	Professional		$78.25	$78.25	$78.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $137.60 / $203.81 / $252.67	Professional	26	$137.60	$203.81	$252.67
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $418.67 / $600.47 / $804.22	Professional	TC	$418.67	$600.47	$804.22
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $152.66 / $152.66 / $153.55	Facility	26	$152.66	$152.66	$153.55
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $672.73 / $1,003.45 / $1,220.35	Professional		$672.73	$1,003.45	$1,220.35
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $174.14 / $260.06 / $316.37	Professional	26	$174.14	$260.06	$316.37
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $497.97 / $740.16 / $919.44	Professional	TC	$497.97	$740.16	$919.44
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $611.23 / $882.99 / $1,245.86	Professional		$611.23	$882.99	$1,245.86
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $155.69 / $232.24 / $314.54	Professional	26	$155.69	$232.24	$314.54
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $455.53 / $650.48 / $950.97	Professional	TC	$455.53	$650.48	$950.97
United Facility/Professional Professional Modifier Low / Median / High Price $412.28 / $507.10 / $1,285.35	Professional		$412.28	$507.10	$1,285.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $104.30 / $128.19 / $322.06	Professional	26	$104.30	$128.19	$322.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $307.98 / $381.52 / $977.97	Professional	TC	$307.98	$381.52	$977.97
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $248.60 / $248.60 / $248.60	Professional		$248.60	$248.60	$248.60
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $118.89 / $118.89 / $118.89	Professional	26	$118.89	$118.89	$118.89
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $129.71 / $129.71 / $129.71	Professional	TC	$129.71	$129.71	$129.71