Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $410.37 / $778.21 / $1,427.59	Facility	26	$410.37	$778.21	$1,427.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,889.42 / $2,326.09 / $5,606.73	Professional		$1,889.42	$2,326.09	$5,606.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $360.87 / $487.73 / $1,104.27	Professional	26	$360.87	$487.73	$1,104.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,516.64 / $1,891.72 / $3,742.57	Professional	TC	$1,516.64	$1,891.72	$3,742.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,449.78 / $1,656.33 / $5,051.04	Professional		$1,449.78	$1,656.33	$5,051.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $353.97 / $451.79 / $835.81	Professional	26	$353.97	$451.79	$835.81
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $554.02 / $1,924.04 / $2,448.63	Facility	26	$554.02	$1,924.04	$2,448.63
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $2,488.33 / $4,358.39 / $15,998.18	Professional		$2,488.33	$4,358.39	$15,998.18
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $570.79 / $990.83 / $3,475.95	Professional	26	$570.79	$990.83	$3,475.95
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,959.16 / $3,367.56 / $12,522.23	Professional	TC	$1,959.16	$3,367.56	$12,522.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,369.01 / $3,829.88 / $6,025.11	Professional		$2,369.01	$3,829.88	$6,025.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $512.87 / $837.29 / $1,333.22	Professional	26	$512.87	$837.29	$1,333.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,878.28 / $2,982.41 / $4,691.89	Professional	TC	$1,878.28	$2,982.41	$4,691.89
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $387.81 / $898.82 / $4,012.89	Facility	26	$387.81	$898.82	$4,012.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,973.15 / $4,250.10 / $5,707.49	Professional		$1,973.15	$4,250.10	$5,707.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $392.68 / $882.95 / $1,121.77	Professional	26	$392.68	$882.95	$1,121.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $1,585.34 / $3,298.81 / $4,585.72	Professional	TC	$1,585.34	$3,298.81	$4,585.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $373.02 / $1,667.07 / $4,097.90	Professional		$373.02	$1,667.07	$4,097.90
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $579.17 / $785.91 / $836.83	Facility	26	$579.17	$785.91	$836.83
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $828.90 / $828.90 / $1,355.39	Professional		$828.90	$828.90	$1,355.39
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $486.42 / $665.50 / $879.75	Professional	26	$486.42	$665.50	$879.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $1,835.82 / $2,458.41 / $3,278.25	Professional	TC	$1,835.82	$2,458.41	$3,278.25
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $554.02 / $554.02 / $570.79	Facility	26	$554.02	$554.02	$570.79
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,832.16 / $4,220.09 / $5,021.71	Professional		$2,832.16	$4,220.09	$5,021.71
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $641.61 / $952.11 / $1,137.46	Professional	26	$641.61	$952.11	$1,137.46
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $2,188.30 / $3,267.98 / $3,888.74	Professional	TC	$2,188.30	$3,267.98	$3,888.74
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,448.63 / $2,448.63 / $3,999.35	Facility	26	$2,448.63	$2,448.63	$3,999.35
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,488.33 / $3,810.66 / $5,194.47	Professional		$2,488.33	$3,810.66	$5,194.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $565.03 / $855.57 / $1,121.84	Professional	26	$565.03	$855.57	$1,121.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $1,923.31 / $2,966.60 / $4,022.92	Professional	TC	$1,923.31	$2,966.60	$4,022.92
United Facility/Professional Professional Modifier Low / Median / High Price $2,327.19 / $2,631.42 / $5,008.88	Professional		$2,327.19	$2,631.42	$5,008.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $492.28 / $540.89 / $1,081.88	Professional	26	$492.28	$540.89	$1,081.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,722.82 / $1,988.63 / $3,870.17	Professional	TC	$1,722.82	$1,988.63	$3,870.17
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $2,139.28 / $2,139.28 / $2,139.28	Professional		$2,139.28	$2,139.28	$2,139.28
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $451.79 / $451.79 / $451.79	Professional	26	$451.79	$451.79	$451.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $1,687.49 / $1,687.49 / $1,687.49	Professional	TC	$1,687.49	$1,687.49	$1,687.49