Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.71 / $52.60 / $134.21	Facility	26	$41.71	$52.60	$134.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.87 / $409.40 / $821.15	Professional		$251.87	$409.40	$821.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.17 / $41.71 / $105.25	Professional	26	$33.17	$41.71	$105.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.71 / $358.96 / $688.35	Professional	TC	$218.71	$358.96	$688.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $231.17 / $555.75 / $890.80	Professional		$231.17	$555.75	$890.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.47 / $59.15 / $98.68	Professional	26	$20.47	$59.15	$98.68
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $49.81 / $100.00 / $731.61	Facility	26	$49.81	$100.00	$731.61
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $414.04 / $709.85 / $2,023.55	Professional		$414.04	$709.85	$2,023.55
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.82 / $86.65 / $267.48	Professional	26	$50.82	$86.65	$267.48
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $374.91 / $639.61 / $1,789.49	Professional	TC	$374.91	$639.61	$1,789.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $416.33 / $658.01 / $1,062.34	Professional		$416.33	$658.01	$1,062.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.96 / $77.16 / $121.48	Professional	26	$48.96	$77.16	$121.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $367.96 / $581.21 / $942.51	Professional	TC	$367.96	$581.21	$942.51
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $35.96 / $89.44 / $1,678.39	Facility	26	$35.96	$89.44	$1,678.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $346.58 / $670.82 / $939.82	Professional		$346.58	$670.82	$939.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.96 / $86.34 / $110.62	Professional	26	$35.96	$86.34	$110.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $310.62 / $622.51 / $898.49	Professional	TC	$310.62	$622.51	$898.49
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 $55.37 / $72.48 / $74.80	Facility	26	$55.37	$72.48	$74.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.22 / $63.84 / $78.95	Professional	26	$44.22	$63.84	$78.95
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $306.77 / $418.31 / $584.91	Professional	TC	$306.77	$418.31	$584.91
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $49.81 / $49.81 / $49.83	Facility	26	$49.81	$49.81	$49.83
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $473.63 / $701.24 / $862.51	Professional		$473.63	$701.24	$862.51
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.51 / $83.70 / $102.17	Professional	26	$56.51	$83.70	$102.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $417.12 / $617.74 / $758.74	Professional	TC	$417.12	$617.74	$758.74
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 $432.43 / $626.95 / $905.90	Professional		$432.43	$626.95	$905.90
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.59 / $75.58 / $102.29	Professional	26	$60.59	$75.58	$102.29
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $439.49 / $563.88 / $804.74	Professional	TC	$439.49	$563.88	$804.74
United Facility/Professional Professional Modifier Low / Median / High Price $229.01 / $343.57 / $875.90	Professional		$229.01	$343.57	$875.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.75 / $41.69 / $100.30	Professional	26	$33.75	$41.69	$100.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $195.28 / $288.92 / $771.39	Professional	TC	$195.28	$288.92	$771.39