Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $141.13 / $339.49 / $834.53	Facility		$141.13	$339.49	$834.53
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.35 / $49.79 / $96.60	Facility	26	$30.35	$49.79	$96.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.93 / $141.13 / $292.18	Professional		$73.93	$141.13	$292.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.78 / $30.36 / $65.27	Professional	26	$23.78	$30.36	$65.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.89 / $110.76 / $185.35	Professional	TC	$49.89	$110.76	$185.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $227.66 / $227.66 / $227.66	Professional		$227.66	$227.66	$227.66
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $158.10 / $272.63 / $516.20	Facility		$158.10	$272.63	$516.20
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $36.10 / $80.00 / $136.28	Facility	26	$36.10	$80.00	$136.28
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $161.24 / $277.06 / $1,004.33	Professional		$161.24	$277.06	$1,004.33
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.24 / $63.46 / $220.05	Professional	26	$38.24	$63.46	$220.05
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $124.28 / $214.19 / $784.28	Professional	TC	$124.28	$214.19	$784.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $119.92 / $249.04 / $378.70	Professional		$119.92	$249.04	$378.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.61 / $55.72 / $80.17	Professional	26	$36.61	$55.72	$80.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.35 / $193.32 / $294.70	Professional	TC	$84.35	$193.32	$294.70
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $101.91 / $172.84 / $267.20	Facility		$101.91	$172.84	$267.20
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $33.95 / $58.00 / $70.44	Facility	26	$33.95	$58.00	$70.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.95 / $172.97 / $290.08	Professional		$107.95	$172.97	$290.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.40 / $58.00 / $72.80	Professional	26	$34.40	$58.00	$72.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $71.51 / $124.12 / $229.38	Professional	TC	$71.51	$124.12	$229.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.68 / $153.91 / $316.25	Professional		$27.68	$153.91	$316.25
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $128.38 / $198.93 / $233.16	Facility		$128.38	$198.93	$233.16
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $39.69 / $52.01 / $53.60	Facility	26	$39.69	$52.01	$53.60
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $37.26 / $48.72 / $62.80	Professional	26	$37.26	$48.72	$62.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $66.73 / $118.30 / $158.47	Professional	TC	$66.73	$118.30	$158.47
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $158.10 / $158.10 / $159.04	Facility		$158.10	$158.10	$159.04
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $36.10 / $36.10 / $36.24	Facility	26	$36.10	$36.10	$36.24
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $163.69 / $266.32 / $326.18	Professional		$163.69	$266.32	$326.18
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.24 / $60.87 / $74.05	Professional	26	$38.24	$60.87	$74.05
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $126.54 / $205.44 / $252.13	Professional	TC	$126.54	$205.44	$252.13
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $124.28 / $124.28 / $124.28	Facility		$124.28	$124.28	$124.28
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $161.24 / $228.78 / $308.14	Professional		$161.24	$228.78	$308.14
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $36.96 / $51.94 / $69.95	Professional	26	$36.96	$51.94	$69.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $124.28 / $176.84 / $238.20	Professional	TC	$124.28	$176.84	$238.20
United Facility/Professional Professional Modifier Low / Median / High Price $103.17 / $115.84 / $319.11	Professional		$103.17	$115.84	$319.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.51 / $28.71 / $74.02	Professional	26	$27.51	$28.71	$74.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.68 / $89.54 / $246.17	Professional	TC	$65.68	$89.54	$246.17