Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.59 / $87.66 / $172.95	Facility	26	$53.59	$87.66	$172.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $267.32 / $425.53 / $851.06	Professional		$267.32	$425.53	$851.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.47 / $53.59 / $128.13	Professional	26	$43.47	$53.59	$128.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $223.84 / $371.94 / $743.88	Professional	TC	$223.84	$371.94	$743.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.09 / $41.93 / $86.09	Professional	26	$26.09	$41.93	$86.09
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $63.42 / $108.00 / $731.61	Facility	26	$63.42	$108.00	$731.61
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $434.15 / $743.72 / $2,116.12	Professional		$434.15	$743.72	$2,116.12
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.68 / $111.07 / $350.03	Professional	26	$64.68	$111.07	$350.03
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $387.62 / $649.85 / $1,817.68	Professional	TC	$387.62	$649.85	$1,817.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $437.10 / $746.41 / $1,111.85	Professional		$437.10	$746.41	$1,111.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.20 / $99.45 / $156.19	Professional	26	$63.20	$99.45	$156.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $369.56 / $646.54 / $956.74	Professional	TC	$369.56	$646.54	$956.74
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $116.88 / $1,678.39	Facility	26	$60.26	$116.88	$1,678.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $356.19 / $748.90 / $1,030.30	Professional		$356.19	$748.90	$1,030.30
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $113.52 / $141.56	Professional	26	$60.26	$113.52	$141.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $310.00 / $674.99 / $930.01	Professional	TC	$310.00	$674.99	$930.01
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 $72.52 / $93.18 / $95.81	Facility	26	$72.52	$93.18	$95.81
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $245.84 / $245.84 / $273.14	Professional		$245.84	$245.84	$273.14
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.08 / $80.94 / $100.82	Professional	26	$57.08	$80.94	$100.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $356.29 / $485.07 / $628.60	Professional	TC	$356.29	$485.07	$628.60
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $63.42 / $63.42 / $64.44	Facility	26	$63.42	$63.42	$64.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $496.23 / $735.03 / $901.54	Professional		$496.23	$735.03	$901.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.43 / $107.48 / $132.16	Professional	26	$72.43	$107.48	$132.16
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $423.80 / $626.16 / $770.17	Professional	TC	$423.80	$626.16	$770.17
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 $452.30 / $657.40 / $933.50	Professional		$452.30	$657.40	$933.50
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $78.38 / $97.57 / $131.84	Professional	26	$78.38	$97.57	$131.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $449.72 / $572.37 / $802.90	Professional	TC	$449.72	$572.37	$802.90
United Facility/Professional Professional Modifier Low / Median / High Price $276.22 / $359.67 / $880.70	Professional		$276.22	$359.67	$880.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.67 / $51.61 / $128.55	Professional	26	$43.67	$51.61	$128.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $259.12 / $319.72 / $752.15	Professional	TC	$259.12	$319.72	$752.15