Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.21 / $42.88 / $85.68	Facility	26	$26.21	$42.88	$85.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $220.54 / $295.04 / $654.29	Professional		$220.54	$295.04	$654.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.60 / $26.21 / $57.45	Professional	26	$20.60	$26.21	$57.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $196.46 / $268.83 / $592.01	Professional	TC	$196.46	$268.83	$592.01
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.23 / $18.23 / $37.15	Professional	26	$18.23	$18.23	$37.15
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $31.08 / $50.00 / $731.61	Facility	26	$31.08	$50.00	$731.61
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $311.85 / $512.75 / $1,459.76	Professional		$311.85	$512.75	$1,459.76
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.88 / $54.35 / $147.05	Professional	26	$31.88	$54.35	$147.05
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $279.97 / $470.26 / $1,312.71	Professional	TC	$279.97	$470.26	$1,312.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $318.92 / $515.77 / $766.90	Professional		$318.92	$515.77	$766.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.13 / $48.26 / $75.94	Professional	26	$31.13	$48.26	$75.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $287.79 / $467.60 / $691.98	Professional	TC	$287.79	$467.60	$691.98
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $29.70 / $57.61 / $1,678.39	Facility	26	$29.70	$57.61	$1,678.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $249.24 / $575.64 / $720.94	Professional		$249.24	$575.64	$720.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.70 / $55.96 / $69.37	Professional	26	$29.70	$55.96	$69.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $226.61 / $519.66 / $655.48	Professional	TC	$226.61	$519.66	$655.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $47.11 / $275.68 / $552.92	Professional		$47.11	$275.68	$552.92
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $37.40 / $45.56 / $47.57	Facility	26	$37.40	$45.56	$47.57
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $29.92 / $42.60 / $48.47	Professional	26	$29.92	$42.60	$48.47
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $290.88 / $365.28 / $442.58	Professional	TC	$290.88	$365.28	$442.58
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $31.08 / $31.08 / $31.26	Facility	26	$31.08	$31.08	$31.26
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $342.12 / $505.42 / $621.66	Professional		$342.12	$505.42	$621.66
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.45 / $52.50 / $63.74	Professional	26	$35.45	$52.50	$63.74
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $306.68 / $452.79 / $556.91	Professional	TC	$306.68	$452.79	$556.91
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $731.61 / $731.61 / $1,177.68	Facility	26	$731.61	$731.61	$1,177.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $311.85 / $462.00 / $651.15	Professional		$311.85	$462.00	$651.15
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.79 / $47.41 / $64.38	Professional	26	$37.79	$47.41	$64.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $325.20 / $417.90 / $586.77	Professional	TC	$325.20	$417.90	$586.77
United Facility/Professional Professional Modifier Low / Median / High Price $210.43 / $259.95 / $607.20	Professional		$210.43	$259.95	$607.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.17 / $26.15 / $65.54	Professional	26	$21.17	$26.15	$65.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $189.26 / $233.80 / $605.66	Professional	TC	$189.26	$233.80	$605.66