Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $220.09 / $417.50 / $765.56	Facility	26	$220.09	$417.50	$765.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $500.73 / $613.49 / $1,401.66	Professional		$500.73	$613.49	$1,401.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $198.28 / $273.58 / $608.61	Professional	26	$198.28	$273.58	$608.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $268.69 / $365.62 / $717.93	Professional	TC	$268.69	$365.62	$717.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $381.81 / $432.32 / $1,277.16	Professional		$381.81	$432.32	$1,277.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $189.73 / $236.71 / $448.00	Professional	26	$189.73	$236.71	$448.00
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $298.07 / $1,325.34 / $2,448.63	Facility	26	$298.07	$1,325.34	$2,448.63
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $644.49 / $1,100.19 / $7,381.05	Professional		$644.49	$1,100.19	$7,381.05
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $306.19 / $530.37 / $1,864.20	Professional	26	$306.19	$530.37	$1,864.20
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $352.80 / $597.86 / $6,233.93	Professional	TC	$352.80	$597.86	$6,233.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $591.37 / $991.59 / $1,559.96	Professional		$591.37	$991.59	$1,559.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $275.26 / $453.05 / $715.22	Professional	26	$275.26	$453.05	$715.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $327.52 / $536.96 / $863.03	Professional	TC	$327.52	$536.96	$863.03
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $208.63 / $510.13 / $4,012.89	Facility	26	$208.63	$510.13	$4,012.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $484.84 / $1,088.25 / $1,540.31	Professional		$484.84	$1,088.25	$1,540.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $210.58 / $485.96 / $603.47	Professional	26	$210.58	$485.96	$603.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $276.52 / $602.29 / $937.98	Professional	TC	$276.52	$602.29	$937.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $77.30 / $435.06 / $969.12	Professional		$77.30	$435.06	$969.12
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $330.75 / $421.43 / $448.90	Facility	26	$330.75	$421.43	$448.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $267.33 / $383.87 / $492.10	Professional	26	$267.33	$383.87	$492.10
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $311.60 / $454.02 / $672.68	Professional	TC	$311.60	$454.02	$672.68
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $298.07 / $298.07 / $306.19	Facility	26	$298.07	$298.07	$306.19
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $734.08 / $1,099.24 / $1,316.95	Professional		$734.08	$1,099.24	$1,316.95
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $344.18 / $510.74 / $610.16	Professional	26	$344.18	$510.74	$610.16
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $391.26 / $588.50 / $700.28	Professional	TC	$391.26	$588.50	$700.28
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,448.63 / $2,448.63 / $3,999.35	Facility	26	$2,448.63	$2,448.63	$3,999.35
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $644.49 / $987.77 / $1,300.46	Professional		$644.49	$987.77	$1,300.46
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $304.00 / $458.95 / $601.79	Professional	26	$304.00	$458.95	$601.79
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $340.49 / $526.22 / $716.45	Professional	TC	$340.49	$526.22	$716.45
United Facility/Professional Professional Modifier Low / Median / High Price $595.35 / $672.35 / $1,357.56	Professional		$595.35	$672.35	$1,357.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $267.64 / $290.52 / $580.35	Professional	26	$267.64	$290.52	$580.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $318.74 / $392.72 / $800.00	Professional	TC	$318.74	$392.72	$800.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $548.35 / $548.35 / $548.35	Professional		$548.35	$548.35	$548.35
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $242.16 / $242.16 / $242.16	Professional	26	$242.16	$242.16	$242.16
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $306.19 / $306.19 / $306.19	Professional	TC	$306.19	$306.19	$306.19