Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.25 / $90.55 / $165.54	Facility	26	$51.25	$90.55	$165.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.31 / $278.02 / $556.04	Professional		$213.31	$278.02	$556.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.96 / $51.26 / $101.44	Professional	26	$40.96	$51.26	$101.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $166.21 / $226.76 / $453.52	Professional	TC	$166.21	$226.76	$453.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $77.86 / $77.86 / $77.86	Professional	26	$77.86	$77.86	$77.86
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $61.61 / $104.00 / $731.61	Facility	26	$61.61	$104.00	$731.61
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $296.83 / $501.76 / $1,481.01	Professional		$296.83	$501.76	$1,481.01
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $62.83 / $102.72 / $501.94	Professional	26	$62.83	$102.72	$501.94
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $236.54 / $397.38 / $1,231.75	Professional	TC	$236.54	$397.38	$1,231.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.82 / $491.91 / $735.27	Professional		$301.82	$491.91	$735.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.97 / $95.14 / $149.41	Professional	26	$60.97	$95.14	$149.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $240.85 / $396.32 / $586.44	Professional	TC	$240.85	$396.32	$586.44
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $44.64 / $113.36 / $1,678.39	Facility	26	$44.64	$113.36	$1,678.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $234.36 / $555.65 / $677.90	Professional		$234.36	$555.65	$677.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.64 / $109.91 / $135.93	Professional	26	$44.64	$109.91	$135.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $189.41 / $441.61 / $566.25	Professional	TC	$189.41	$441.61	$566.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $42.34 / $232.19 / $468.46	Professional		$42.34	$232.19	$468.46
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $71.05 / $89.18 / $92.48	Facility	26	$71.05	$89.18	$92.48
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $270.14 / $270.14 / $270.14	Professional		$270.14	$270.14	$270.14
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $64.73 / $82.61 / $95.88	Professional	26	$64.73	$82.61	$95.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $245.76 / $318.60 / $377.01	Professional	TC	$245.76	$318.60	$377.01
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $61.61 / $61.61 / $61.70	Facility	26	$61.61	$61.61	$61.70
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $327.23 / $484.69 / $593.35	Professional		$327.23	$484.69	$593.35
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.34 / $102.91 / $126.54	Professional	26	$69.34	$102.91	$126.54
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $257.88 / $381.97 / $472.19	Professional	TC	$257.88	$381.97	$472.19
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 $299.38 / $445.90 / $617.12	Professional		$299.38	$445.90	$617.12
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $75.05 / $93.42 / $126.68	Professional	26	$75.05	$93.42	$126.68
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $275.73 / $351.40 / $491.12	Professional	TC	$275.73	$351.40	$491.12
United Facility/Professional Professional Modifier Low / Median / High Price $199.70 / $247.38 / $580.75	Professional		$199.70	$247.38	$580.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.54 / $50.53 / $123.09	Professional	26	$41.54	$50.53	$123.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $157.68 / $194.78 / $476.89	Professional	TC	$157.68	$194.78	$476.89