Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $161.78 / $232.27 / $423.93	Facility	26	$161.78	$232.27	$423.93
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $243.88 / $271.27 / $468.96	Facility	53	$243.88	$271.27	$468.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $742.21 / $1,191.97 / $2,378.39	Professional		$742.21	$1,191.97	$2,378.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $116.25 / $193.88 / $550.84	Professional	26	$116.25	$193.88	$550.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $316.98 / $575.63 / $920.39	Professional	52	$316.98	$575.63	$920.39
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $126.79 / $230.25 / $368.16	Professional	53	$126.79	$230.25	$368.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $618.97 / $966.10 / $1,660.43	Professional	TC	$618.97	$966.10	$1,660.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $944.76 / $944.76 / $1,119.71	Professional		$944.76	$944.76	$1,119.71
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $240.00 / $789.30 / $789.30	Facility	26	$240.00	$789.30	$789.30
Asuris Northwest Health Facility/Professional Facility Modifier 53 Low / Median / High Price $193.34 / $643.30 / $643.30	Facility	53	$193.34	$643.30	$643.30
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,056.40 / $1,790.87 / $6,328.35	Professional		$1,056.40	$1,790.87	$6,328.35
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $154.28 / $292.20 / $1,044.83	Professional	26	$154.28	$292.20	$1,044.83
Asuris Northwest Health Facility/Professional Professional Modifier 53 Low / Median / High Price $744.80 / $744.80 / $918.40	Professional	53	$744.80	$744.80	$918.40
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $898.04 / $1,510.44 / $5,415.68	Professional	TC	$898.04	$1,510.44	$5,415.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $905.76 / $1,536.70 / $2,404.00	Professional		$905.76	$1,536.70	$2,404.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $135.43 / $228.63 / $371.59	Professional	26	$135.43	$228.63	$371.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $768.84 / $1,293.34 / $2,074.48	Professional	TC	$768.84	$1,293.34	$2,074.48
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $156.60 / $305.33 / $2,246.13	Facility	26	$156.60	$305.33	$2,246.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $903.96 / $1,828.80 / $2,319.28	Professional		$903.96	$1,828.80	$2,319.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $156.60 / $275.95 / $438.33	Professional	26	$156.60	$275.95	$438.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $783.06 / $1,481.89 / $2,001.39	Professional	TC	$783.06	$1,481.89	$2,001.39
Molina Facility/Professional Professional Modifier Low / Median / High Price $120.96 / $670.67 / $1,672.53	Professional		$120.96	$670.67	$1,672.53
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $181.43 / $221.10 / $294.54	Facility	26	$181.43	$221.10	$294.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $183.54 / $266.80 / $342.20	Professional	26	$183.54	$266.80	$342.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $881.60 / $1,120.05 / $1,525.30	Professional	TC	$881.60	$1,120.05	$1,525.30
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $150.40 / $150.40 / $150.81	Facility	26	$150.40	$150.40	$150.81
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,151.10 / $1,724.41 / $2,213.64	Professional		$1,151.10	$1,724.41	$2,213.64
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $169.60 / $259.51 / $331.72	Professional	26	$169.60	$259.51	$331.72
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $977.99 / $1,464.56 / $1,892.67	Professional	TC	$977.99	$1,464.56	$1,892.67
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,570.62 / $1,570.62 / $2,505.71	Facility	26	$1,570.62	$1,570.62	$2,505.71
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,077.38 / $1,515.48 / $2,097.32	Professional		$1,077.38	$1,515.48	$2,097.32
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $153.38 / $217.79 / $324.17	Professional	26	$153.38	$217.79	$324.17
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $924.00 / $1,287.11 / $1,788.35	Professional	TC	$924.00	$1,287.11	$1,788.35
United Facility/Professional Professional Modifier Low / Median / High Price $916.99 / $1,456.98 / $2,353.58	Professional		$916.99	$1,456.98	$2,353.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $142.74 / $248.40 / $356.86	Professional	26	$142.74	$248.40	$356.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $786.32 / $1,221.88 / $1,988.14	Professional	TC	$786.32	$1,221.88	$1,988.14
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $810.72 / $810.72 / $810.72	Professional		$810.72	$810.72	$810.72
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $116.69 / $116.69 / $116.69	Professional	26	$116.69	$116.69	$116.69
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $694.03 / $694.03 / $694.03	Professional	TC	$694.03	$694.03	$694.03