Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.00 / $63.87 / $125.61	Facility	26	$39.00	$63.87	$125.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $300.52 / $403.73 / $885.79	Professional		$300.52	$403.73	$885.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.39 / $39.01 / $83.60	Professional	26	$30.39	$39.01	$83.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $270.12 / $364.72 / $798.86	Professional	TC	$270.12	$364.72	$798.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $226.32 / $226.32 / $226.32	Professional		$226.32	$226.32	$226.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.21 / $28.52 / $92.34	Professional	26	$19.21	$28.52	$92.34
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $46.66 / $80.00 / $731.61	Facility	26	$46.66	$80.00	$731.61
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $422.66 / $698.30 / $1,991.14	Professional		$422.66	$698.30	$1,991.14
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.59 / $81.13 / $218.97	Professional	26	$47.59	$81.13	$218.97
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $377.92 / $633.30 / $1,772.11	Professional	TC	$377.92	$633.30	$1,772.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $437.37 / $702.09 / $1,044.30	Professional		$437.37	$702.09	$1,044.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.28 / $72.43 / $113.75	Professional	26	$46.28	$72.43	$113.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $391.09 / $629.16 / $931.10	Professional	TC	$391.09	$629.16	$931.10
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $34.10 / $84.77 / $1,678.39	Facility	26	$34.10	$84.77	$1,678.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $358.67 / $757.99 / $988.16	Professional		$358.67	$757.99	$988.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.10 / $82.34 / $103.12	Professional	26	$34.10	$82.34	$103.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $325.19 / $697.16 / $908.43	Professional	TC	$325.19	$697.16	$908.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $49.85 / $366.55 / $724.73	Professional		$49.85	$366.55	$724.73
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $56.60 / $67.81 / $69.68	Facility	26	$56.60	$67.81	$69.68
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $245.84 / $245.84 / $245.84	Professional		$245.84	$245.84	$245.84
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $43.68 / $66.20 / $72.09	Professional	26	$43.68	$66.20	$72.09
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $362.88 / $505.78 / $627.52	Professional	TC	$362.88	$505.78	$627.52
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $46.66 / $46.66 / $47.07	Facility	26	$46.66	$46.66	$47.07
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $465.93 / $688.86 / $847.28	Professional		$465.93	$688.86	$847.28
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.91 / $78.52 / $96.54	Professional	26	$52.91	$78.52	$96.54
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $413.01 / $611.76 / $749.22	Professional	TC	$413.01	$611.76	$749.22
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 $425.50 / $629.67 / $893.03	Professional		$425.50	$629.67	$893.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.26 / $71.28 / $96.66	Professional	26	$57.26	$71.28	$96.66
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $437.49 / $562.79 / $797.38	Professional	TC	$437.49	$562.79	$797.38
United Facility/Professional Professional Modifier Low / Median / High Price $287.74 / $355.45 / $900.61	Professional		$287.74	$355.45	$900.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.59 / $39.03 / $93.89	Professional	26	$31.59	$39.03	$93.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $256.14 / $314.36 / $733.03	Professional	TC	$256.14	$314.36	$733.03