Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $274.08 / $925.73 / $1,549.38	Facility		$274.08	$925.73	$1,549.38
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.90 / $46.27 / $94.77	Facility	26	$41.90	$46.27	$94.77
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $232.16 / $369.52 / $1,102.24	Facility	TC	$232.16	$369.52	$1,102.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $183.68 / $259.05 / $546.36	Professional		$183.68	$259.05	$546.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.89 / $43.50 / $140.72	Professional	26	$31.89	$43.50	$140.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.80 / $220.00 / $428.27	Professional	TC	$151.80	$220.00	$428.27
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.44 / $213.27 / $369.34	Professional		$144.44	$213.27	$369.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.83 / $53.25 / $58.58	Professional	26	$25.83	$53.25	$58.58
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $283.99 / $283.99 / $283.99	Professional	TC	$283.99	$283.99	$283.99
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $401.27 / $695.98 / $938.39	Facility		$401.27	$695.98	$938.39
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $75.65 / $212.00 / $212.00	Facility	26	$75.65	$212.00	$212.00
Asuris Northwest Health Facility/Professional Facility Modifier TC Low / Median / High Price $305.67 / $446.45 / $691.80	Facility	TC	$305.67	$446.45	$691.80
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $261.49 / $474.20 / $1,626.45	Professional		$261.49	$474.20	$1,626.45
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.74 / $76.45 / $889.65	Professional	26	$45.74	$76.45	$889.65
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $215.75 / $387.61 / $1,388.59	Professional	TC	$215.75	$387.61	$1,388.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $475.81 / $831.68 / $1,144.41	Facility		$475.81	$831.68	$1,144.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $235.26 / $374.82 / $614.45	Professional		$235.26	$374.82	$614.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.13 / $60.64 / $102.77	Professional	26	$36.13	$60.64	$102.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.71 / $306.26 / $519.12	Professional	TC	$194.71	$306.26	$519.12
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $223.86 / $385.38 / $626.09	Facility		$223.86	$385.38	$626.09
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $31.93 / $70.48 / $115.69	Facility	26	$31.93	$70.48	$115.69
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $184.86 / $339.30 / $558.41	Facility	TC	$184.86	$339.30	$558.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $211.27 / $394.78 / $595.28	Professional		$211.27	$394.78	$595.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.93 / $68.34 / $86.28	Professional	26	$31.93	$68.34	$86.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $181.54 / $326.43 / $511.50	Professional	TC	$181.54	$326.43	$511.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.53 / $232.19 / $486.37	Professional		$41.53	$232.19	$486.37
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $304.05 / $364.14 / $420.75	Facility		$304.05	$364.14	$420.75
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $52.74 / $62.93 / $66.33	Facility	26	$52.74	$62.93	$66.33
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $251.31 / $301.20 / $322.42	Facility	TC	$251.31	$301.20	$322.42
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $40.60 / $57.00 / $72.75	Professional	26	$40.60	$57.00	$72.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $204.53 / $281.60 / $380.56	Professional	TC	$204.53	$281.60	$380.56
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $256.38 / $256.38 / $256.39	Facility		$256.38	$256.38	$256.39
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $44.33 / $44.33 / $44.85	Facility	26	$44.33	$44.33	$44.85
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $211.55 / $211.55 / $212.05	Facility	TC	$211.55	$211.55	$212.05
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $291.26 / $429.91 / $525.83	Professional		$291.26	$429.91	$525.83
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.52 / $74.56 / $90.92	Professional	26	$50.52	$74.56	$90.92
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $240.74 / $355.34 / $434.91	Professional	TC	$240.74	$355.34	$434.91
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $450.37 / $694.41 / $1,328.33	Facility		$450.37	$694.41	$1,328.33
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $782.93	Facility	26	$446.45	$446.45	$782.93
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $446.45 / $446.45 / $782.93	Facility	TC	$446.45	$446.45	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $261.49 / $368.80 / $496.77	Professional		$261.49	$368.80	$496.77
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $45.74 / $63.76 / $85.89	Professional	26	$45.74	$63.76	$85.89
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $215.75 / $305.04 / $410.87	Professional	TC	$215.75	$305.04	$410.87
United Facility/Professional Professional Modifier Low / Median / High Price $220.40 / $352.82 / $545.50	Professional		$220.40	$352.82	$545.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.39 / $57.42 / $99.43	Professional	26	$39.39	$57.42	$99.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $186.60 / $295.49 / $450.88	Professional	TC	$186.60	$295.49	$450.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $213.27 / $213.27 / $213.27	Professional		$213.27	$213.27	$213.27
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.28 / $33.28 / $33.28	Professional	26	$33.28	$33.28	$33.28
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $179.99 / $179.99 / $179.99	Professional	TC	$179.99	$179.99	$179.99