Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.66 / $217.69 / $341.64	Facility	26	$97.66	$217.69	$341.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $692.07 / $1,105.27 / $2,188.25	Professional		$692.07	$1,105.27	$2,188.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $626.09 / $1,007.61 / $1,970.55	Professional	TC	$626.09	$1,007.61	$1,970.55
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $134.99 / $451.11 / $1,374.41	Facility	26	$134.99	$451.11	$1,374.41
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,352.51 / $2,286.29 / $8,256.45	Professional		$1,352.51	$2,286.29	$8,256.45
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,235.84 / $2,049.89 / $7,390.88	Professional	TC	$1,235.84	$2,049.89	$7,390.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $909.02 / $1,855.11 / $3,091.90	Professional		$909.02	$1,855.11	$3,091.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $789.53 / $1,660.01 / $2,778.94	Professional	TC	$789.53	$1,660.01	$2,778.94
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $101.06 / $222.09 / $2,160.25	Facility	26	$101.06	$222.09	$2,160.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $927.31 / $1,629.58 / $2,601.44	Professional		$927.31	$1,629.58	$2,601.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $822.80 / $1,404.92 / $2,362.67	Professional	TC	$822.80	$1,404.92	$2,362.67
Molina Facility/Professional Professional Modifier Low / Median / High Price $117.55 / $883.23 / $2,191.58	Professional		$117.55	$883.23	$2,191.58
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $161.21 / $191.01 / $202.64	Facility	26	$161.21	$191.01	$202.64
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $486.90 / $486.90 / $490.08	Professional		$486.90	$486.90	$490.08
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $833.17 / $1,251.90 / $1,633.99	Professional	TC	$833.17	$1,251.90	$1,633.99
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $134.99 / $134.99 / $136.63	Facility	26	$134.99	$134.99	$136.63
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,480.48 / $2,194.29 / $2,643.52	Professional		$1,480.48	$2,194.29	$2,643.52
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,327.40 / $1,962.86 / $2,376.98	Professional	TC	$1,327.40	$1,962.86	$2,376.98
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,374.41 / $1,374.41 / $2,406.69	Facility	26	$1,374.41	$1,374.41	$2,406.69
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,373.53 / $1,961.82 / $2,658.46	Professional		$1,373.53	$1,961.82	$2,658.46
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $1,235.84 / $1,754.91 / $2,379.78	Professional	TC	$1,235.84	$1,754.91	$2,379.78
United Facility/Professional Professional Modifier Low / Median / High Price $823.68 / $1,082.69 / $2,395.81	Professional		$823.68	$1,082.69	$2,395.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $695.19 / $1,013.00 / $2,454.81	Professional	TC	$695.19	$1,013.00	$2,454.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,097.68 / $1,097.68 / $1,097.68	Professional		$1,097.68	$1,097.68	$1,097.68
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $994.54 / $994.54 / $994.54	Professional	TC	$994.54	$994.54	$994.54