Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $389.45 / $493.27 / $809.86	Facility	26	$389.45	$493.27	$809.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $920.36 / $1,487.23 / $2,628.00	Professional		$920.36	$1,487.23	$2,628.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $286.89 / $389.46 / $1,170.66	Professional	26	$286.89	$389.46	$1,170.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $654.73 / $1,120.25 / $1,925.74	Professional	TC	$654.73	$1,120.25	$1,925.74
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $390.49 / $2,654.96 / $5,624.10	Facility	26	$390.49	$2,654.96	$5,624.10
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,483.94 / $2,453.69 / $8,950.04	Professional		$1,483.94	$2,453.69	$8,950.04
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $398.43 / $676.82 / $2,490.23	Professional	26	$398.43	$676.82	$2,490.23
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,085.70 / $1,789.02 / $6,459.75	Professional	TC	$1,085.70	$1,789.02	$6,459.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,327.21 / $2,204.01 / $3,319.29	Professional		$1,327.21	$2,204.01	$3,319.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $392.09 / $585.10 / $854.86	Professional	26	$392.09	$585.10	$854.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $935.12 / $1,618.91 / $2,429.66	Professional	TC	$935.12	$1,618.91	$2,429.66
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $362.86 / $654.33 / $10,775.99	Facility	26	$362.86	$654.33	$10,775.99
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,472.09 / $2,212.48 / $2,983.89	Professional		$1,472.09	$2,212.48	$2,983.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $362.86 / $630.84 / $802.52	Professional	26	$362.86	$630.84	$802.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $864.07 / $1,506.64 / $2,068.67	Professional	TC	$864.07	$1,506.64	$2,068.67
Molina Facility/Professional Professional Modifier Low / Median / High Price $182.56 / $834.14 / $2,132.68	Professional		$182.56	$834.14	$2,132.68
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $461.58 / $548.16 / $586.16	Facility	26	$461.58	$548.16	$586.16
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,039.70 / $2,039.70 / $2,039.70	Professional		$2,039.70	$2,039.70	$2,039.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $346.00 / $492.14 / $586.95	Professional	26	$346.00	$492.14	$586.95
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $850.63 / $1,201.18 / $1,485.39	Professional	TC	$850.63	$1,201.18	$1,485.39
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $390.49 / $390.49 / $392.56	Facility	26	$390.49	$390.49	$392.56
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,504.23 / $2,370.19 / $2,836.83	Professional		$1,504.23	$2,370.19	$2,836.83
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $412.88 / $650.57 / $779.20	Professional	26	$412.88	$650.57	$779.20
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,091.34 / $1,719.63 / $2,058.17	Professional	TC	$1,091.34	$1,719.63	$2,058.17
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $5,624.10 / $5,624.10 / $9,482.39	Facility	26	$5,624.10	$5,624.10	$9,482.39
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,483.94 / $2,022.16 / $2,723.80	Professional		$1,483.94	$2,022.16	$2,723.80
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $398.24 / $564.71 / $760.64	Professional	26	$398.24	$564.71	$760.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $1,085.70 / $1,457.45 / $1,963.15	Professional	TC	$1,085.70	$1,457.45	$1,963.15
United Facility/Professional Professional Modifier Low / Median / High Price $1,338.04 / $1,885.42 / $3,010.57	Professional		$1,338.04	$1,885.42	$3,010.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $359.52 / $546.37 / $867.41	Professional	26	$359.52	$546.37	$867.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $937.23 / $1,254.54 / $2,182.02	Professional	TC	$937.23	$1,254.54	$2,182.02