Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $148.22 / $199.18 / $338.63	Facility	26	$148.22	$199.18	$338.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $581.88 / $842.74 / $1,551.87	Professional		$581.88	$842.74	$1,551.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.29 / $149.13 / $300.00	Professional	26	$114.29	$149.13	$300.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $258.77 / $388.94 / $602.65	Professional	52	$258.77	$388.94	$602.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $465.22 / $694.51 / $1,287.49	Professional	TC	$465.22	$694.51	$1,287.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $611.89 / $635.89 / $888.23	Professional		$611.89	$635.89	$888.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $146.12 / $209.19 / $236.48	Professional	26	$146.12	$209.19	$236.48
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $164.98 / $753.90 / $753.90	Facility	26	$164.98	$753.90	$753.90
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $623.77 / $1,091.46 / $6,200.00	Professional		$623.77	$1,091.46	$6,200.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $125.19 / $224.72 / $1,081.48	Professional	26	$125.19	$224.72	$1,081.48
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $530.25 / $974.45 / $4,665.53	Professional	TC	$530.25	$974.45	$4,665.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $708.54 / $1,191.54 / $2,008.81	Professional		$708.54	$1,191.54	$2,008.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $133.01 / $218.56 / $362.38	Professional	26	$133.01	$218.56	$362.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $576.60 / $968.00 / $1,646.44	Professional	TC	$576.60	$968.00	$1,646.44
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $118.58 / $208.45 / $416.69	Facility	26	$118.58	$208.45	$416.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $587.92 / $935.37 / $1,737.75	Professional		$587.92	$935.37	$1,737.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $112.64 / $185.93 / $331.85	Professional	26	$112.64	$185.93	$331.85
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $475.29 / $759.68 / $1,423.11	Professional	TC	$475.29	$759.68	$1,423.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $128.75 / $570.85 / $1,572.48	Professional		$128.75	$570.85	$1,572.48
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $189.14 / $239.29 / $245.48	Facility	26	$189.14	$239.29	$245.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $151.11 / $208.62 / $273.60	Professional	26	$151.11	$208.62	$273.60
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $609.03 / $860.81 / $1,104.00	Professional	TC	$609.03	$860.81	$1,104.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $163.53 / $163.53 / $164.98	Facility	26	$163.53	$163.53	$164.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $920.57 / $1,444.95 / $1,775.19	Professional		$920.57	$1,444.95	$1,775.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $173.28 / $273.92 / $327.85	Professional	26	$173.28	$273.92	$327.85
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $766.08 / $1,171.03 / $1,447.73	Professional	TC	$766.08	$1,171.03	$1,447.73
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 $650.70 / $684.95 / $1,384.58	Professional		$650.70	$684.95	$1,384.58
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $120.03 / $126.35 / $280.32	Professional	26	$120.03	$126.35	$280.32
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $530.25 / $538.65 / $1,025.74	Professional	TC	$530.25	$538.65	$1,025.74
United Facility/Professional Professional Modifier Low / Median / High Price $719.20 / $1,222.64 / $1,910.40	Professional		$719.20	$1,222.64	$1,910.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $136.04 / $237.30 / $353.79	Professional	26	$136.04	$237.30	$353.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $561.60 / $964.80 / $1,485.92	Professional	TC	$561.60	$964.80	$1,485.92
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $543.86 / $657.95 / $759.44	Professional		$543.86	$657.95	$759.44
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $99.93 / $118.24 / $126.78	Professional	26	$99.93	$118.24	$126.78
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $443.92 / $539.71 / $632.66	Professional	TC	$443.92	$539.71	$632.66