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 $427.44 / $517.91 / $1,308.93	Professional		$427.44	$517.91	$1,308.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $195.71 / $264.77 / $608.61	Professional	26	$195.71	$264.77	$608.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $239.11 / $297.79 / $667.62	Professional	TC	$239.11	$297.79	$667.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $378.84 / $520.91 / $1,249.46	Professional		$378.84	$520.91	$1,249.46
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $189.73 / $242.16 / $448.00	Professional	26	$189.73	$242.16	$448.00
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $298.07 / $1,030.91 / $1,030.91	Facility	26	$298.07	$1,030.91	$1,030.91
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $622.30 / $1,089.85 / $4,017.68	Professional		$622.30	$1,089.85	$4,017.68
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $304.00 / $527.76 / $1,867.13	Professional	26	$304.00	$527.76	$1,867.13
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $321.56 / $566.79 / $2,150.63	Professional	TC	$321.56	$566.79	$2,150.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $612.79 / $981.48 / $1,497.22	Professional		$612.79	$981.48	$1,497.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $275.26 / $453.05 / $716.32	Professional	26	$275.26	$453.05	$716.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $348.94 / $516.16 / $803.67	Professional	TC	$348.94	$516.16	$803.67
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $208.63 / $510.13 / $1,073.72	Facility	26	$208.63	$510.13	$1,073.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $503.13 / $1,046.54 / $1,455.34	Professional		$503.13	$1,046.54	$1,455.34
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 $294.50 / $563.90 / $807.18	Professional	TC	$294.50	$563.90	$807.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $69.50 / $403.04 / $945.05	Professional		$69.50	$403.04	$945.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $314.08 / $421.43 / $449.57	Facility	26	$314.08	$421.43	$449.57
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $251.65 / $371.78 / $449.57	Professional	26	$251.65	$371.78	$449.57
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $324.39 / $443.46 / $549.64	Professional	TC	$324.39	$443.46	$549.64
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $298.07 / $298.07 / $306.64	Facility	26	$298.07	$298.07	$306.64
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $714.48 / $1,071.79 / $1,288.86	Professional		$714.48	$1,071.79	$1,288.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $344.18 / $511.50 / $610.16	Professional	26	$344.18	$511.50	$610.16
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $369.10 / $560.29 / $666.72	Professional	TC	$369.10	$560.29	$666.72
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 $622.30 / $959.06 / $1,319.39	Professional		$622.30	$959.06	$1,319.39
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $304.00 / $459.64 / $602.69	Professional	26	$304.00	$459.64	$602.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $318.32 / $500.21 / $689.72	Professional	TC	$318.32	$500.21	$689.72
United Facility/Professional Professional Modifier Low / Median / High Price $573.59 / $635.58 / $1,201.33	Professional		$573.59	$635.58	$1,201.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $278.89 / $297.98 / $636.44	Professional	26	$278.89	$297.98	$636.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $303.30 / $343.40 / $652.79	Professional	TC	$303.30	$343.40	$652.79
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $535.60 / $535.60 / $535.60	Professional		$535.60	$535.60	$535.60
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 $293.44 / $293.44 / $293.44	Professional	TC	$293.44	$293.44	$293.44