Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.93 / $206.63 / $410.49	Facility	26	$126.93	$206.63	$410.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $302.68 / $461.44 / $954.23	Professional		$302.68	$461.44	$954.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.00 / $126.93 / $315.89	Professional	26	$86.00	$126.93	$315.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $212.09 / $311.01 / $670.83	Professional	TC	$212.09	$311.01	$670.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $326.60 / $326.60 / $326.60	Professional		$326.60	$326.60	$326.60
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $119.94 / $201.28 / $300.33	Professional	26	$119.94	$201.28	$300.33
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $1,048.24 / $1,048.24	Facility	26	$346.39	$1,048.24	$1,048.24
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $506.54 / $1,007.71 / $4,801.00	Professional		$506.54	$1,007.71	$4,801.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $153.38 / $263.60 / $1,632.94	Professional	26	$153.38	$263.60	$1,632.94
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $427.18 / $745.53 / $3,601.00	Professional	TC	$427.18	$745.53	$3,601.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $438.32 / $789.42 / $1,417.79	Professional		$438.32	$789.42	$1,417.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $111.27 / $203.34 / $352.44	Professional	26	$111.27	$203.34	$352.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $321.17 / $614.38 / $1,079.58	Professional	TC	$321.17	$614.38	$1,079.58
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $138.16 / $257.77 / $539.79	Facility	26	$138.16	$257.77	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $437.43 / $935.95 / $1,360.26	Professional		$437.43	$935.95	$1,360.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $124.08 / $249.38 / $306.12	Professional	26	$124.08	$249.38	$306.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $326.35 / $702.35 / $1,051.08	Professional	TC	$326.35	$702.35	$1,051.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $48.08 / $249.08 / $578.88	Professional		$48.08	$249.08	$578.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $182.60 / $219.91 / $227.80	Facility	26	$182.60	$219.91	$227.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $153.44 / $204.00 / $252.75	Professional	26	$153.44	$204.00	$252.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $361.90 / $506.41 / $731.20	Professional	TC	$361.90	$506.41	$731.20
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $150.40 / $150.40 / $151.72	Facility	26	$150.40	$150.40	$151.72
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $656.23 / $995.27 / $1,203.33	Professional		$656.23	$995.27	$1,203.33
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $171.65 / $261.08 / $316.06	Professional	26	$171.65	$261.08	$316.06
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $482.88 / $733.86 / $888.35	Professional	TC	$482.88	$733.86	$888.35
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $346.39 / $851.78	Facility	26	$346.39	$346.39	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $589.04 / $874.69 / $1,149.97	Professional		$589.04	$874.69	$1,149.97
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $153.38 / $229.74 / $309.94	Professional	26	$153.38	$229.74	$309.94
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $435.67 / $644.94 / $874.59	Professional	TC	$435.67	$644.94	$874.59
United Facility/Professional Professional Modifier Low / Median / High Price $383.15 / $512.09 / $1,209.33	Professional		$383.15	$512.09	$1,209.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $102.77 / $139.99 / $331.06	Professional	26	$102.77	$139.99	$331.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $280.38 / $408.47 / $893.00	Professional	TC	$280.38	$408.47	$893.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $333.33 / $333.33 / $333.33	Professional		$333.33	$333.33	$333.33
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $116.52 / $116.52 / $116.52	Professional	26	$116.52	$116.52	$116.52
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $216.81 / $216.81 / $216.81	Professional	TC	$216.81	$216.81	$216.81