Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.06 / $99.10 / $162.44	Facility	26	$69.06	$99.10	$162.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $377.83 / $479.20 / $991.58	Professional		$377.83	$479.20	$991.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.71 / $69.06 / $123.55	Professional	26	$51.71	$69.06	$123.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $322.70 / $411.86 / $845.85	Professional	TC	$322.70	$411.86	$845.85
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $689.09 / $689.09 / $689.09	Professional		$689.09	$689.09	$689.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $97.27 / $97.27 / $109.06	Professional	26	$97.27	$97.27	$109.06
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $76.78 / $416.00 / $416.00	Facility	26	$76.78	$416.00	$416.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $430.92 / $790.84 / $3,905.69	Professional		$430.92	$790.84	$3,905.69
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.45 / $105.74 / $617.51	Professional	26	$58.45	$105.74	$617.51
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $373.10 / $608.66 / $3,576.06	Professional	TC	$373.10	$608.66	$3,576.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $441.23 / $767.49 / $1,332.31	Professional		$441.23	$767.49	$1,332.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.93 / $104.23 / $168.83	Professional	26	$61.93	$104.23	$168.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $366.68 / $660.95 / $1,163.49	Professional	TC	$366.68	$660.95	$1,163.49
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $55.38 / $97.35 / $204.95	Facility	26	$55.38	$97.35	$204.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $361.92 / $605.89 / $1,045.46	Professional		$361.92	$605.89	$1,045.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.39 / $86.83 / $154.35	Professional	26	$52.39	$86.83	$154.35
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $306.95 / $493.15 / $914.65	Professional	TC	$306.95	$493.15	$914.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $48.85 / $504.36 / $1,079.71	Professional		$48.85	$504.36	$1,079.71
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.18 / $111.19 / $118.32	Facility	26	$89.18	$111.19	$118.32
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.36 / $101.40 / $134.49	Professional	26	$66.36	$101.40	$134.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $403.21 / $577.41 / $759.24	Professional	TC	$403.21	$577.41	$759.24
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $76.09 / $76.09 / $76.78	Facility	26	$76.09	$76.09	$76.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $609.51 / $942.19 / $1,175.59	Professional		$609.51	$942.19	$1,175.59
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.09 / $127.07 / $152.38	Professional	26	$79.09	$127.07	$152.38
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $530.61 / $823.29 / $1,023.21	Professional	TC	$530.61	$823.29	$1,023.21
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $946.29 / $946.29 / $3,043.22	Facility	26	$946.29	$946.29	$3,043.22
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $430.92 / $453.60 / $916.92	Professional		$430.92	$453.60	$916.92
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $55.86 / $58.80 / $130.44	Professional	26	$55.86	$58.80	$130.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $373.10 / $378.70 / $721.15	Professional	TC	$373.10	$378.70	$721.15
United Facility/Professional Professional Modifier Low / Median / High Price $461.61 / $708.22 / $1,186.55	Professional		$461.61	$708.22	$1,186.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.56 / $117.60 / $166.02	Professional	26	$70.56	$117.60	$166.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $421.26 / $606.80 / $1,027.90	Professional	TC	$421.26	$606.80	$1,027.90
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $363.31 / $440.12 / $510.44	Professional		$363.31	$440.12	$510.44
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $46.38 / $54.93 / $58.95	Professional	26	$46.38	$54.93	$58.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $316.93 / $385.19 / $451.49	Professional	TC	$316.93	$385.19	$451.49