Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.63 / $102.99 / $201.77	Facility	26	$62.63	$102.99	$201.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $324.50 / $389.90 / $971.13	Professional		$324.50	$389.90	$971.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.03 / $62.63 / $140.13	Professional	26	$49.03	$62.63	$140.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $266.93 / $336.10 / $830.96	Professional	TC	$266.93	$336.10	$830.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $88.84 / $88.84 / $88.84	Professional	26	$88.84	$88.84	$88.84
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $74.75 / $116.34 / $731.61	Facility	26	$74.75	$116.34	$731.61
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $457.27 / $752.96 / $2,141.04	Professional		$457.27	$752.96	$2,141.04
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.23 / $130.76 / $351.55	Professional	26	$76.23	$130.76	$351.55
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $381.61 / $639.61 / $1,789.49	Professional	TC	$381.61	$639.61	$1,789.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $471.73 / $753.13 / $1,123.16	Professional		$471.73	$753.13	$1,123.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.33 / $116.76 / $183.38	Professional	26	$74.33	$116.76	$183.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $397.41 / $636.36 / $941.77	Professional	TC	$397.41	$636.36	$941.77
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $54.56 / $136.63 / $1,678.39	Facility	26	$54.56	$136.63	$1,678.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $367.35 / $812.09 / $1,062.58	Professional		$367.35	$812.09	$1,062.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.56 / $132.71 / $166.87	Professional	26	$54.56	$132.71	$166.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $312.79 / $714.29 / $913.89	Professional	TC	$312.79	$714.29	$913.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.03 / $366.80 / $724.73	Professional		$50.03	$366.80	$724.73
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $90.69 / $108.98 / $111.89	Facility	26	$90.69	$108.98	$111.89
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $363.48 / $363.48 / $363.48	Professional		$363.48	$363.48	$363.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.73 / $100.20 / $126.99	Professional	26	$66.73	$100.20	$126.99
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $340.09 / $512.38 / $659.09	Professional	TC	$340.09	$512.38	$659.09
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $74.75 / $74.75 / $75.41	Facility	26	$74.75	$74.75	$75.41
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $502.40 / $743.81 / $914.87	Professional		$502.40	$743.81	$914.87
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $85.27 / $127.71 / $154.65	Professional	26	$85.27	$127.71	$154.65
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $417.12 / $617.85 / $757.79	Professional	TC	$417.12	$617.85	$757.79
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 $457.84 / $679.91 / $963.85	Professional		$457.84	$679.91	$963.85
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $91.72 / $114.18 / $154.84	Professional	26	$91.72	$114.18	$154.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $442.50 / $568.40 / $810.26	Professional	TC	$442.50	$568.40	$810.26
United Facility/Professional Professional Modifier Low / Median / High Price $310.45 / $383.49 / $929.11	Professional		$310.45	$383.49	$929.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.89 / $62.91 / $157.69	Professional	26	$50.89	$62.91	$157.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $259.52 / $318.97 / $740.31	Professional	TC	$259.52	$318.97	$740.31