Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $142.87 / $165.74 / $325.62	Facility	26	$142.87	$165.74	$325.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $555.67 / $807.14 / $1,460.92	Professional		$555.67	$807.14	$1,460.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.17 / $142.88 / $316.98	Professional	26	$110.17	$142.88	$316.98
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $247.60 / $360.15 / $576.84	Professional	52	$247.60	$360.15	$576.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $442.08 / $664.26 / $1,210.22	Professional	TC	$442.08	$664.26	$1,210.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $606.98 / $606.98 / $978.93	Professional		$606.98	$606.98	$978.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $181.52 / $194.67 / $225.09	Professional	26	$181.52	$194.67	$225.09
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $158.58 / $701.13 / $701.13	Facility	26	$158.58	$701.13	$701.13
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $600.61 / $1,010.13 / $6,200.00	Professional		$600.61	$1,010.13	$6,200.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $120.18 / $214.21 / $2,600.00	Professional	26	$120.18	$214.21	$2,600.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $507.06 / $843.03 / $7,000.00	Professional	TC	$507.06	$843.03	$7,000.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $678.68 / $1,134.50 / $1,921.73	Professional		$678.68	$1,134.50	$1,921.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $127.89 / $210.31 / $348.46	Professional	26	$127.89	$210.31	$348.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $549.15 / $922.88 / $1,573.26	Professional	TC	$549.15	$922.88	$1,573.26
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $113.89 / $198.95 / $398.00	Facility	26	$113.89	$198.95	$398.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $559.77 / $882.85 / $1,650.96	Professional		$559.77	$882.85	$1,650.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $108.26 / $176.18 / $319.83	Professional	26	$108.26	$176.18	$319.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $451.82 / $721.72 / $1,320.25	Professional	TC	$451.82	$721.72	$1,320.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $126.30 / $546.37 / $1,483.54	Professional		$126.30	$546.37	$1,483.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $180.81 / $229.74 / $236.64	Facility	26	$180.81	$229.74	$236.64
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $131.76 / $184.50 / $256.52	Professional	26	$131.76	$184.50	$256.52
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $525.49 / $791.16 / $1,072.08	Professional	TC	$525.49	$791.16	$1,072.08
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $157.63 / $157.63 / $158.58	Facility	26	$157.63	$157.63	$158.58
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $880.59 / $1,360.94 / $1,698.09	Professional		$880.59	$1,360.94	$1,698.09
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $166.56 / $264.02 / $316.01	Professional	26	$166.56	$264.02	$316.01
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $732.00 / $1,117.00 / $1,383.33	Professional	TC	$732.00	$1,117.00	$1,383.33
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,784.45 / $1,784.45 / $3,043.22	Facility	26	$1,784.45	$1,784.45	$3,043.22
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $622.44 / $655.20 / $1,324.44	Professional		$622.44	$655.20	$1,324.44
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $115.38 / $121.80 / $269.45	Professional	26	$115.38	$121.80	$269.45
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $507.06 / $513.79 / $978.42	Professional	TC	$507.06	$513.79	$978.42
United Facility/Professional Professional Modifier Low / Median / High Price $688.40 / $1,107.08 / $1,728.74	Professional		$688.40	$1,107.08	$1,728.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $134.55 / $234.51 / $346.56	Professional	26	$134.55	$234.51	$346.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $525.99 / $832.47 / $1,417.34	Professional	TC	$525.99	$832.47	$1,417.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $519.29 / $628.27 / $725.13	Professional		$519.29	$628.27	$725.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $95.79 / $113.45 / $121.67	Professional	26	$95.79	$113.45	$121.67
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $423.49 / $514.82 / $603.46	Professional	TC	$423.49	$514.82	$603.46