Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $76.29 / $122.06 / $220.61	Facility	26	$76.29	$122.06	$220.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $439.18 / $604.62 / $1,016.79	Professional		$439.18	$604.62	$1,016.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.28 / $76.29 / $165.93	Professional	26	$64.28	$76.29	$165.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $369.97 / $528.33 / $867.97	Professional	TC	$369.97	$528.33	$867.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $797.67 / $797.67 / $797.67	Professional		$797.67	$797.67	$797.67
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.72 / $107.20 / $128.41	Professional	26	$36.72	$107.20	$128.41
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $90.49 / $140.27 / $2,533.52	Facility	26	$90.49	$140.27	$2,533.52
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $633.40 / $1,048.49 / $2,964.79	Professional		$633.40	$1,048.49	$2,964.79
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $92.40 / $157.54 / $546.15	Professional	26	$92.40	$157.54	$546.15
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $541.00 / $901.63 / $3,229.80	Professional	TC	$541.00	$901.63	$3,229.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $633.52 / $1,025.05 / $1,527.87	Professional		$633.52	$1,025.05	$1,527.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.84 / $139.83 / $220.67	Professional	26	$90.84	$139.83	$220.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $542.67 / $885.22 / $1,310.15	Professional	TC	$542.67	$885.22	$1,310.15
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $86.57 / $167.91 / $6,255.42	Facility	26	$86.57	$167.91	$6,255.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $602.64 / $1,168.80 / $1,486.87	Professional		$602.64	$1,168.80	$1,486.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $86.57 / $162.21 / $200.62	Professional	26	$86.57	$162.21	$200.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $516.07 / $972.19 / $1,260.76	Professional	TC	$516.07	$972.19	$1,260.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $49.77 / $497.95 / $982.20	Professional		$49.77	$497.95	$982.20
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $108.90 / $131.71 / $136.68	Facility	26	$108.90	$131.71	$136.68
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $712.20 / $712.20 / $712.20	Professional		$712.20	$712.20	$712.20
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $87.12 / $108.90 / $132.66	Professional	26	$87.12	$108.90	$132.66
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $591.74 / $709.68 / $741.69	Professional	TC	$591.74	$709.68	$741.69
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $90.49 / $90.49 / $90.60	Facility	26	$90.49	$90.49	$90.60
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $687.84 / $1,018.85 / $1,242.35	Professional		$687.84	$1,018.85	$1,242.35
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.74 / $152.18 / $185.59	Professional	26	$102.74	$152.18	$185.59
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $585.10 / $866.67 / $1,053.85	Professional	TC	$585.10	$866.67	$1,053.85
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,533.52 / $2,533.52 / $4,287.53	Facility	26	$2,533.52	$2,533.52	$4,287.53
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $633.40 / $903.06 / $1,273.78	Professional		$633.40	$903.06	$1,273.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $92.40 / $137.02 / $185.80	Professional	26	$92.40	$137.02	$185.80
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $541.00 / $782.58 / $1,096.72	Professional	TC	$541.00	$782.58	$1,096.72
United Facility/Professional Professional Modifier Low / Median / High Price $431.34 / $507.78 / $1,226.61	Professional		$431.34	$507.78	$1,226.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.54 / $76.91 / $189.99	Professional	26	$62.54	$76.91	$189.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $369.03 / $455.87 / $1,082.06	Professional	TC	$369.03	$455.87	$1,082.06