Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.62 / $161.36 / $263.30	Facility	26	$81.62	$161.36	$263.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $342.85 / $468.52 / $1,020.10	Professional		$342.85	$468.52	$1,020.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.56 / $81.62 / $179.33	Professional	26	$68.56	$81.62	$179.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $274.27 / $380.26 / $849.50	Professional	TC	$274.27	$380.26	$849.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $57.32 / $57.32 / $132.44	Professional	26	$57.32	$57.32	$132.44
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $98.30 / $152.75 / $949.44	Facility	26	$98.30	$152.75	$949.44
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $568.04 / $945.53 / $2,692.02	Professional		$568.04	$945.53	$2,692.02
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.25 / $170.93 / $462.06	Professional	26	$100.25	$170.93	$462.06
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $475.40 / $789.28 / $2,230.02	Professional	TC	$475.40	$789.28	$2,230.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $546.29 / $878.52 / $1,392.35	Professional		$546.29	$878.52	$1,392.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.45 / $152.72 / $239.92	Professional	26	$97.45	$152.72	$239.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $448.85 / $719.00 / $1,154.79	Professional	TC	$448.85	$719.00	$1,154.79
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $71.30 / $181.24 / $2,162.39	Facility	26	$71.30	$181.24	$2,162.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $189.31 / $794.60 / $1,228.47	Professional		$189.31	$794.60	$1,228.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $71.30 / $176.61 / $218.43	Professional	26	$71.30	$176.61	$218.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $353.09 / $809.93 / $1,035.85	Professional	TC	$353.09	$809.93	$1,035.85
Molina Facility/Professional Professional Modifier Low / Median / High Price $83.50 / $358.39 / $875.94	Professional		$83.50	$358.39	$875.94
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $118.80 / $143.47 / $146.72	Facility	26	$118.80	$143.47	$146.72
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $87.64 / $129.63 / $150.41	Professional	26	$87.64	$129.63	$150.41
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $410.84 / $592.76 / $695.83	Professional	TC	$410.84	$592.76	$695.83
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $98.30 / $98.30 / $98.71	Facility	26	$98.30	$98.30	$98.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $626.20 / $927.54 / $1,134.78	Professional		$626.20	$927.54	$1,134.78
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $111.47 / $167.18 / $202.46	Professional	26	$111.47	$167.18	$202.46
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $514.73 / $762.42 / $929.15	Professional	TC	$514.73	$762.42	$929.15
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $949.44 / $949.44 / $1,526.97	Facility	26	$949.44	$949.44	$1,526.97
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $575.65 / $843.34 / $1,148.69	Professional		$575.65	$843.34	$1,148.69
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $120.07 / $149.47 / $202.69	Professional	26	$120.07	$149.47	$202.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $542.55 / $699.79 / $959.30	Professional	TC	$542.55	$699.79	$959.30
United Facility/Professional Professional Modifier Low / Median / High Price $363.16 / $476.15 / $1,158.04	Professional		$363.16	$476.15	$1,158.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.88 / $82.62 / $197.85	Professional	26	$66.88	$82.62	$197.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $296.88 / $389.87 / $922.34	Professional	TC	$296.88	$389.87	$922.34