Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $729.37 / $1,914.24 / $17,930.00	Facility		$729.37	$1,914.24	$17,930.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $159.79 / $272.54 / $363.36	Facility	26	$159.79	$272.54	$363.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $327.50 / $540.72 / $919.12	Professional		$327.50	$540.72	$919.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $122.12 / $159.79 / $342.05	Professional	26	$122.12	$159.79	$342.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $214.11 / $376.97 / $601.66	Professional	TC	$214.11	$376.97	$601.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $371.52 / $371.52 / $377.54	Professional	TC	$371.52	$371.52	$377.54
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $285.95 / $1,819.61 / $3,703.07	Facility		$285.95	$1,819.61	$3,703.07
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $165.80 / $239.59 / $1,115.05	Facility	26	$165.80	$239.59	$1,115.05
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $541.00 / $918.64 / $3,322.73	Professional		$541.00	$918.64	$3,322.73
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $174.37 / $292.73 / $1,045.58	Professional	26	$174.37	$292.73	$1,045.58
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $371.91 / $625.91 / $2,277.15	Professional	TC	$371.91	$625.91	$2,277.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $321.93 / $321.93 / $536.33	Facility		$321.93	$321.93	$536.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $438.24 / $820.71 / $1,239.65	Professional		$438.24	$820.71	$1,239.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $161.68 / $255.63 / $372.68	Professional	26	$161.68	$255.63	$372.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $276.55 / $565.08 / $855.61	Professional	TC	$276.55	$565.08	$855.61
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $339.05 / $690.34 / $1,260.93	Facility		$339.05	$690.34	$1,260.93
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $154.05 / $277.37 / $1,701.49	Facility	26	$154.05	$277.37	$1,701.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $339.05 / $684.94 / $949.30	Professional		$339.05	$684.94	$949.30
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $154.05 / $263.17 / $319.62	Professional	26	$154.05	$263.17	$319.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $263.12 / $435.86 / $671.92	Professional	TC	$263.12	$435.86	$671.92
Molina Facility/Professional Professional Modifier Low / Median / High Price $57.75 / $338.47 / $811.14	Professional		$57.75	$338.47	$811.14
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $479.22 / $667.47 / $778.54	Facility		$479.22	$667.47	$778.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $193.45 / $242.33 / $248.88	Facility	26	$193.45	$242.33	$248.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $171.45 / $232.02 / $279.10	Professional	26	$171.45	$232.02	$279.10
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $268.64 / $374.26 / $523.27	Professional	TC	$268.64	$374.26	$523.27
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $285.95 / $526.01 / $530.46	Facility		$285.95	$526.01	$530.46
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $165.80 / $165.80 / $169.09	Facility	26	$165.80	$165.80	$169.09
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $541.42 / $881.12 / $1,078.83	Professional		$541.42	$881.12	$1,078.83
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $177.34 / $282.05 / $346.80	Professional	26	$177.34	$282.05	$346.80
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $367.67 / $600.35 / $732.03	Professional	TC	$367.67	$600.35	$732.03
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,255.31 / $1,934.75 / $3,703.07	Facility		$1,255.31	$1,934.75	$3,703.07
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,115.05 / $1,115.05 / $1,906.19	Facility	26	$1,115.05	$1,115.05	$1,906.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $541.00 / $756.67 / $1,019.21	Professional		$541.00	$756.67	$1,019.21
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $169.09 / $243.24 / $327.64	Professional	26	$169.09	$243.24	$327.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $371.91 / $513.42 / $691.58	Professional	TC	$371.91	$513.42	$691.58
United Facility/Professional Facility Modifier Low / Median / High Price $591.00 / $1,106.00 / $4,911.00	Facility		$591.00	$1,106.00	$4,911.00
United Facility/Professional Professional Modifier Low / Median / High Price $448.14 / $757.67 / $1,118.04	Professional		$448.14	$757.67	$1,118.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $161.05 / $256.20 / $356.26	Professional	26	$161.05	$256.20	$356.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $294.42 / $556.32 / $761.78	Professional	TC	$294.42	$556.32	$761.78