Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.90 / $93.40 / $271.51	Facility	26	$84.90	$93.40	$271.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $433.43 / $592.63 / $1,902.36	Professional		$433.43	$592.63	$1,902.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.62 / $84.91 / $218.86	Professional	26	$67.62	$84.91	$218.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $365.81 / $496.73 / $1,111.54	Professional	TC	$365.81	$496.73	$1,111.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $697.22 / $697.22 / $781.74	Professional		$697.22	$697.22	$781.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $66.41 / $120.30 / $145.82	Professional	26	$66.41	$120.30	$145.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $576.94 / $576.94 / $657.36	Professional	TC	$576.94	$576.94	$657.36
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $101.91 / $157.88 / $2,533.52	Facility	26	$101.91	$157.88	$2,533.52
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $611.04 / $1,010.79 / $2,898.56	Professional		$611.04	$1,010.79	$2,898.56
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $103.95 / $175.16 / $479.37	Professional	26	$103.95	$175.16	$479.37
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $516.04 / $856.23 / $2,419.25	Professional	TC	$516.04	$856.23	$2,419.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $625.66 / $1,018.26 / $1,518.60	Professional		$625.66	$1,018.26	$1,518.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.19 / $158.34 / $248.29	Professional	26	$100.19	$158.34	$248.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $525.48 / $859.57 / $1,272.49	Professional	TC	$525.48	$859.57	$1,272.49
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $95.49 / $186.18 / $5,739.12	Facility	26	$95.49	$186.18	$5,739.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $487.01 / $1,072.95 / $1,453.12	Professional		$487.01	$1,072.95	$1,453.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $95.49 / $172.69 / $225.93	Professional	26	$95.49	$172.69	$225.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $413.54 / $900.75 / $1,227.18	Professional	TC	$413.54	$900.75	$1,227.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $89.14 / $389.29 / $959.71	Professional		$89.14	$389.29	$959.71
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $112.21 / $147.69 / $151.63	Facility	26	$112.21	$147.69	$151.63
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $593.22 / $923.72 / $1,251.05	Professional		$593.22	$923.72	$1,251.05
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $103.05 / $127.68 / $150.08	Professional	26	$103.05	$127.68	$150.08
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $503.00 / $657.78 / $784.57	Professional	TC	$503.00	$657.78	$784.57
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $101.91 / $101.91 / $101.93	Facility	26	$101.91	$101.91	$101.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $673.46 / $997.54 / $1,234.53	Professional		$673.46	$997.54	$1,234.53
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $115.07 / $172.60 / $209.02	Professional	26	$115.07	$172.60	$209.02
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $558.39 / $832.82 / $1,024.34	Professional	TC	$558.39	$832.82	$1,024.34
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,533.52 / $2,533.52 / $4,053.27	Facility	26	$2,533.52	$2,533.52	$4,053.27
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $620.00 / $898.91 / $1,278.38	Professional		$620.00	$898.91	$1,278.38
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $123.97 / $154.32 / $209.26	Professional	26	$123.97	$154.32	$209.26
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $598.15 / $760.90 / $1,071.45	Professional	TC	$598.15	$760.90	$1,071.45
United Facility/Professional Professional Modifier Low / Median / High Price $411.98 / $506.35 / $1,245.45	Professional		$411.98	$506.35	$1,245.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.72 / $89.60 / $208.37	Professional	26	$68.72	$89.60	$208.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $343.26 / $424.03 / $991.01	Professional	TC	$343.26	$424.03	$991.01