Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $183.91 / $341.60 / $12,042.12	Facility		$183.91	$341.60	$12,042.12
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.57 / $129.10 / $189.76	Facility	26	$90.57	$129.10	$189.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $135.19 / $235.93 / $424.02	Professional		$135.19	$235.93	$424.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.68 / $79.95 / $181.16	Professional	26	$50.68	$79.95	$181.16
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $62.65 / $91.96 / $186.73	Professional	52	$62.65	$91.96	$186.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.14 / $162.66 / $347.30	Professional	TC	$68.14	$162.66	$347.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $144.04 / $144.04 / $144.04	Professional	26	$144.04	$144.04	$144.04
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,406.32 / $7,307.41 / $11,933.63	Facility		$1,406.32	$7,307.41	$11,933.63
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $166.72 / $366.35 / $366.35	Facility	26	$166.72	$366.35	$366.35
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $208.82 / $360.90 / $3,102.49	Professional		$208.82	$360.90	$3,102.49
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $111.05 / $192.77 / $691.35	Professional	26	$111.05	$192.77	$691.35
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $99.84 / $185.93 / $2,808.09	Professional	TC	$99.84	$185.93	$2,808.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $5,105.59 / $10,818.66 / $13,141.64	Facility		$5,105.59	$10,818.66	$13,141.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $175.09 / $310.26 / $513.79	Professional		$175.09	$310.26	$513.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.97 / $133.55 / $243.01	Professional	26	$66.97	$133.55	$243.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $86.76 / $165.32 / $371.28	Professional	TC	$86.76	$165.32	$371.28
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $207.10 / $403.82 / $7,397.05	Facility		$207.10	$403.82	$7,397.05
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $75.33 / $140.25 / $8,105.48	Facility	26	$75.33	$140.25	$8,105.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $167.40 / $355.32 / $610.01	Professional		$167.40	$355.32	$610.01
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.33 / $139.34 / $213.96	Professional	26	$75.33	$139.34	$213.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $103.93 / $187.49 / $481.29	Professional	TC	$103.93	$187.49	$481.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.52 / $132.70 / $296.28	Professional		$26.52	$132.70	$296.28
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $243.91 / $296.72 / $524.66	Facility		$243.91	$296.72	$524.66
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $151.41 / $164.15	Facility	26	$91.20	$151.41	$164.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $73.79 / $98.91 / $164.15	Professional	26	$73.79	$98.91	$164.15
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $112.24 / $181.50 / $336.24	Professional	TC	$112.24	$181.50	$336.24
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $204.76 / $204.76 / $205.65	Facility		$204.76	$204.76	$205.65
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $110.53 / $110.53 / $111.05	Facility	26	$110.53	$110.53	$111.05
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $232.29 / $354.33 / $434.30	Professional		$232.29	$354.33	$434.30
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $119.30 / $188.08 / $231.29	Professional	26	$119.30	$188.08	$231.29
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $106.85 / $162.99 / $205.92	Professional	TC	$106.85	$162.99	$205.92
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $5,650.51 / $8,807.33 / $17,177.93	Facility		$5,650.51	$8,807.33	$17,177.93
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $5,551.62 / $5,551.62 / $8,401.03	Facility	26	$5,551.62	$5,551.62	$8,401.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $208.82 / $311.39 / $447.89	Professional		$208.82	$311.39	$447.89
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $112.73 / $167.65 / $226.94	Professional	26	$112.73	$167.65	$226.94
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $99.84 / $144.90 / $220.71	Professional	TC	$99.84	$144.90	$220.71
United Facility/Professional Professional Modifier Low / Median / High Price $167.09 / $226.86 / $457.54	Professional		$167.09	$226.86	$457.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.37 / $96.76 / $230.86	Professional	26	$60.37	$96.76	$230.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.05 / $133.74 / $247.82	Professional	TC	$78.05	$133.74	$247.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $162.35 / $162.35 / $162.35	Professional		$162.35	$162.35	$162.35
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $82.87 / $82.87 / $82.87	Professional	26	$82.87	$82.87	$82.87
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $79.48 / $79.48 / $79.48	Professional	TC	$79.48	$79.48	$79.48