Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.14 / $70.86 / $145.16	Facility	26	$45.14	$70.86	$145.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.62 / $367.94 / $819.00	Professional		$229.62	$367.94	$819.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.75 / $45.14 / $119.98	Professional	26	$36.75	$45.14	$119.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.87 / $240.20 / $607.05	Professional	TC	$192.87	$240.20	$607.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $206.18 / $495.36 / $802.19	Professional		$206.18	$495.36	$802.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.10 / $64.04 / $76.89	Professional	26	$22.10	$64.04	$76.89
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $53.45 / $100.00 / $731.61	Facility	26	$53.45	$100.00	$731.61
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $369.26 / $635.16 / $1,813.42	Professional		$369.26	$635.16	$1,813.42
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.52 / $90.55 / $328.57	Professional	26	$54.52	$90.55	$328.57
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $329.00 / $556.12 / $1,562.23	Professional	TC	$329.00	$556.12	$1,562.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $373.59 / $588.37 / $946.34	Professional		$373.59	$588.37	$946.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.83 / $83.56 / $131.58	Professional	26	$53.83	$83.56	$131.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $323.41 / $505.24 / $816.51	Professional	TC	$323.41	$505.24	$816.51
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $39.36 / $98.77 / $1,678.39	Facility	26	$39.36	$98.77	$1,678.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $312.48 / $608.37 / $838.63	Professional		$312.48	$608.37	$838.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.36 / $95.94 / $119.90	Professional	26	$39.36	$95.94	$119.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $273.11 / $547.16 / $789.99	Professional	TC	$273.11	$547.16	$789.99
Molina Facility/Professional Professional Modifier Low / Median / High Price $49.21 / $321.22 / $637.87	Professional		$49.21	$321.22	$637.87
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $61.25 / $78.50 / $81.06	Facility	26	$61.25	$78.50	$81.06
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 $48.24 / $73.20 / $84.49	Professional	26	$48.24	$73.20	$84.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $260.86 / $360.18 / $509.87	Professional	TC	$260.86	$360.18	$509.87
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $53.45 / $53.45 / $53.93	Facility	26	$53.45	$53.45	$53.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $423.80 / $627.00 / $769.22	Professional		$423.80	$627.00	$769.22
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.13 / $90.55 / $110.60	Professional	26	$61.13	$90.55	$110.60
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $362.67 / $537.20 / $656.88	Professional	TC	$362.67	$537.20	$656.88
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 $387.62 / $560.70 / $818.53	Professional		$387.62	$560.70	$818.53
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.59 / $81.76 / $111.28	Professional	26	$65.59	$81.76	$111.28
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $378.43 / $488.18 / $707.25	Professional	TC	$378.43	$488.18	$707.25
United Facility/Professional Professional Modifier Low / Median / High Price $223.27 / $322.75 / $827.63	Professional		$223.27	$322.75	$827.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.11 / $45.85 / $113.06	Professional	26	$37.11	$45.85	$113.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $179.06 / $258.17 / $670.69	Professional	TC	$179.06	$258.17	$670.69