Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $131.32 / $224.72 / $300.73	Facility	26	$131.32	$224.72	$300.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $312.81 / $495.10 / $906.97	Professional		$312.81	$495.10	$906.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.11 / $131.32 / $300.73	Professional	26	$100.11	$131.32	$300.73
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $170.00 / $213.01 / $320.01	Professional	52	$170.00	$213.01	$320.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $206.93 / $376.50 / $596.09	Professional	TC	$206.93	$376.50	$596.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $531.51 / $531.51 / $531.51	Professional		$531.51	$531.51	$531.51
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $136.81 / $193.59 / $1,115.05	Facility	26	$136.81	$193.59	$1,115.05
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $511.90 / $867.87 / $3,148.35	Professional		$511.90	$867.87	$3,148.35
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $143.47 / $241.16 / $857.93	Professional	26	$143.47	$241.16	$857.93
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $372.37 / $626.71 / $2,290.50	Professional	TC	$372.37	$626.71	$2,290.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $408.44 / $776.75 / $1,181.58	Professional		$408.44	$776.75	$1,181.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $134.15 / $210.96 / $307.64	Professional	26	$134.15	$210.96	$307.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $274.30 / $565.79 / $861.34	Professional	TC	$274.30	$565.79	$861.34
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $127.74 / $228.67 / $1,701.49	Facility	26	$127.74	$228.67	$1,701.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $342.93 / $638.91 / $901.30	Professional		$342.93	$638.91	$901.30
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $127.74 / $218.22 / $265.02	Professional	26	$127.74	$218.22	$265.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $260.58 / $431.03 / $672.62	Professional	TC	$260.58	$431.03	$672.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $57.46 / $296.75 / $751.08	Professional		$57.46	$296.75	$751.08
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $160.06 / $199.99 / $204.68	Facility	26	$160.06	$199.99	$204.68
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $202.77 / $202.77 / $317.18	Professional		$202.77	$202.77	$317.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $139.99 / $191.82 / $235.50	Professional	26	$139.99	$191.82	$235.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $271.19 / $386.88 / $487.21	Professional	TC	$271.19	$386.88	$487.21
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $136.81 / $136.81 / $139.38	Facility	26	$136.81	$136.81	$139.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $513.21 / $832.42 / $1,022.59	Professional		$513.21	$832.42	$1,022.59
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $145.31 / $232.50 / $285.88	Professional	26	$145.31	$232.50	$285.88
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $369.73 / $601.11 / $736.72	Professional	TC	$369.73	$601.11	$736.72
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,115.05 / $1,115.05 / $1,906.19	Facility	26	$1,115.05	$1,115.05	$1,906.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $511.90 / $717.22 / $966.08	Professional		$511.90	$717.22	$966.08
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $139.52 / $200.51 / $270.08	Professional	26	$139.52	$200.51	$270.08
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $372.37 / $516.71 / $696.00	Professional	TC	$372.37	$516.71	$696.00
United Facility/Professional Professional Modifier Low / Median / High Price $420.00 / $715.81 / $1,056.27	Professional		$420.00	$715.81	$1,056.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $132.88 / $211.40 / $298.98	Professional	26	$132.88	$211.40	$298.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $283.81 / $481.07 / $750.50	Professional	TC	$283.81	$481.07	$750.50