Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.13 / $174.60 / $317.36	Facility	26	$109.13	$174.60	$317.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $806.01 / $1,140.71 / $2,090.87	Professional		$806.01	$1,140.71	$2,090.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.12 / $109.13 / $264.01	Professional	26	$84.12	$109.13	$264.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $725.23 / $1,031.58 / $1,711.90	Professional	TC	$725.23	$1,031.58	$1,711.90
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $174.55 / $174.55 / $174.55	Professional	26	$174.55	$174.55	$174.55
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $129.79 / $200.99 / $2,871.86	Facility	26	$129.79	$200.99	$2,871.86
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,202.11 / $1,950.93 / $5,628.92	Professional		$1,202.11	$1,950.93	$5,628.92
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $132.59 / $226.86 / $784.28	Professional	26	$132.59	$226.86	$784.28
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,069.53 / $1,769.17 / $6,365.25	Professional	TC	$1,069.53	$1,769.17	$6,365.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,192.85 / $1,945.73 / $2,895.07	Professional		$1,192.85	$1,945.73	$2,895.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $129.12 / $201.07 / $316.56	Professional	26	$129.12	$201.07	$316.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,063.74 / $1,745.06 / $2,582.79	Professional	TC	$1,063.74	$1,745.06	$2,582.79
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $122.65 / $237.87 / $7,019.31	Facility	26	$122.65	$237.87	$7,019.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,134.83 / $2,200.96 / $2,746.59	Professional		$1,134.83	$2,200.96	$2,746.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $122.65 / $231.05 / $288.75	Professional	26	$122.65	$231.05	$288.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $1,012.19 / $1,906.80 / $2,471.30	Professional	TC	$1,012.19	$1,906.80	$2,471.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $119.43 / $749.24 / $1,852.01	Professional		$119.43	$749.24	$1,852.01
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $156.19 / $189.09 / $194.30	Facility	26	$156.19	$189.09	$194.30
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $828.57 / $828.57 / $828.57	Professional		$828.57	$828.57	$828.57
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $103.84 / $156.19 / $190.28	Professional	26	$103.84	$156.19	$190.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $1,164.20 / $1,395.77 / $1,579.86	Professional	TC	$1,164.20	$1,395.77	$1,579.86
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $129.79 / $129.79 / $130.01	Facility	26	$129.79	$129.79	$130.01
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,301.72 / $1,928.12 / $2,347.63	Professional		$1,301.72	$1,928.12	$2,347.63
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $147.94 / $219.14 / $266.19	Professional	26	$147.94	$219.14	$266.19
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,153.77 / $1,708.98 / $2,077.26	Professional	TC	$1,153.77	$1,708.98	$2,077.26
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,871.86 / $2,871.86 / $4,863.74	Facility	26	$2,871.86	$2,871.86	$4,863.74
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,202.11 / $1,706.47 / $2,395.17	Professional		$1,202.11	$1,706.47	$2,395.17
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $132.59 / $196.53 / $266.51	Professional	26	$132.59	$196.53	$266.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $1,069.53 / $1,543.77 / $2,141.46	Professional	TC	$1,069.53	$1,543.77	$2,141.46
United Facility/Professional Professional Modifier Low / Median / High Price $811.78 / $1,003.43 / $2,542.44	Professional		$811.78	$1,003.43	$2,542.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $88.90 / $113.45 / $278.44	Professional	26	$88.90	$113.45	$278.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $722.88 / $889.04 / $2,133.67	Professional	TC	$722.88	$889.04	$2,133.67