Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.09 / $152.60 / $279.85	Facility	26	$80.09	$152.60	$279.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $478.37 / $594.37 / $1,398.32	Professional		$478.37	$594.37	$1,398.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.98 / $95.18 / $252.63	Professional	26	$68.98	$95.18	$252.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $405.41 / $515.29 / $1,131.41	Professional	TC	$405.41	$515.29	$1,131.41
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $343.29 / $394.82 / $1,311.23	Professional		$343.29	$394.82	$1,311.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $69.11 / $88.22 / $163.21	Professional	26	$69.11	$88.22	$163.21
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $109.17 / $1,357.70 / $1,357.70	Facility	26	$109.17	$1,357.70	$1,357.70
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $626.47 / $1,039.48 / $4,499.00	Professional		$626.47	$1,039.48	$4,499.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $111.34 / $186.42 / $1,350.00	Professional	26	$111.34	$186.42	$1,350.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $515.13 / $879.77 / $3,199.95	Professional	TC	$515.13	$879.77	$3,199.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $628.10 / $946.31 / $1,465.74	Professional		$628.10	$946.31	$1,465.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.70 / $162.83 / $261.45	Professional	26	$100.70	$162.83	$261.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $531.72 / $794.41 / $1,223.81	Professional	TC	$531.72	$794.41	$1,223.81
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $76.26 / $175.32 / $1,073.72	Facility	26	$76.26	$175.32	$1,073.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $525.14 / $1,049.83 / $1,504.68	Professional		$525.14	$1,049.83	$1,504.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.97 / $173.62 / $220.58	Professional	26	$76.97	$173.62	$220.58
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $448.88 / $889.61 / $1,254.36	Professional	TC	$448.88	$889.61	$1,254.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $91.76 / $418.69 / $1,043.58	Professional		$91.76	$418.69	$1,043.58
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $112.70 / $154.10 / $164.15	Facility	26	$112.70	$154.10	$164.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $94.87 / $127.68 / $161.00	Professional	26	$94.87	$127.68	$161.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $505.60 / $634.04 / $869.97	Professional	TC	$505.60	$634.04	$869.97
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $109.17 / $109.17 / $111.97	Facility	26	$109.17	$109.17	$111.97
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $697.99 / $1,030.26 / $1,258.79	Professional		$697.99	$1,030.26	$1,258.79
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $125.86 / $186.76 / $223.12	Professional	26	$125.86	$186.76	$223.12
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $571.69 / $849.85 / $1,029.16	Professional	TC	$571.69	$849.85	$1,029.16
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $657.04 / $657.04 / $1,088.88	Facility	26	$657.04	$657.04	$1,088.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $626.47 / $929.36 / $1,265.84	Professional		$626.47	$929.36	$1,265.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $111.34 / $167.83 / $220.06	Professional	26	$111.34	$167.83	$220.06
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $515.13 / $759.82 / $1,050.00	Professional	TC	$515.13	$759.82	$1,050.00
United Facility/Professional Professional Modifier Low / Median / High Price $569.51 / $635.17 / $1,227.49	Professional		$569.51	$635.17	$1,227.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.73 / $106.47 / $212.21	Professional	26	$95.73	$106.47	$212.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $469.76 / $528.71 / $1,011.08	Professional	TC	$469.76	$528.71	$1,011.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $511.70 / $511.70 / $511.70	Professional		$511.70	$511.70	$511.70
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $88.22 / $88.22 / $88.22	Professional	26	$88.22	$88.22	$88.22
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $423.47 / $423.47 / $423.47	Professional	TC	$423.47	$423.47	$423.47