Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.99 / $103.22 / $204.28	Facility	26	$62.99	$103.22	$204.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.22 / $197.96 / $500.31	Professional		$162.22	$197.96	$500.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.54 / $62.99 / $173.03	Professional	26	$51.54	$62.99	$173.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $110.68 / $137.88 / $313.85	Professional	TC	$110.68	$137.88	$313.85
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $327.81 / $327.81 / $327.81	Professional		$327.81	$327.81	$327.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.75 / $49.29 / $149.15	Professional	26	$30.75	$49.29	$149.15
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $75.20 / $116.71 / $949.44	Facility	26	$75.20	$116.71	$949.44
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $239.32 / $383.32 / $1,809.00	Professional		$239.32	$383.32	$1,809.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.69 / $125.55 / $543.00	Professional	26	$76.69	$125.55	$543.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $162.62 / $274.08 / $1,266.00	Professional	TC	$162.62	$274.08	$1,266.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $230.28 / $380.00 / $606.44	Professional		$230.28	$380.00	$606.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.77 / $116.38 / $182.77	Professional	26	$74.77	$116.38	$182.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $155.51 / $260.54 / $424.70	Professional	TC	$155.51	$260.54	$424.70
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $54.87 / $139.02 / $2,162.39	Facility	26	$54.87	$139.02	$2,162.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $177.01 / $423.89 / $522.94	Professional		$177.01	$423.89	$522.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.87 / $134.16 / $165.93	Professional	26	$54.87	$134.16	$165.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $122.45 / $284.79 / $366.15	Professional	TC	$122.45	$284.79	$366.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.10 / $190.19 / $385.40	Professional		$36.10	$190.19	$385.40
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $85.75 / $109.65 / $113.23	Facility	26	$85.75	$109.65	$113.23
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $351.98 / $351.98 / $538.88	Professional		$351.98	$351.98	$538.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $67.59 / $96.75 / $112.56	Professional	26	$67.59	$96.75	$112.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $138.29 / $196.94 / $236.51	Professional	TC	$138.29	$196.94	$236.51
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $75.20 / $75.20 / $75.41	Facility	26	$75.20	$75.20	$75.41
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $267.12 / $400.21 / $492.08	Professional		$267.12	$400.21	$492.08
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.76 / $125.78 / $154.65	Professional	26	$84.76	$125.78	$154.65
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $182.36 / $277.07 / $337.43	Professional	TC	$182.36	$277.07	$337.43
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $949.44 / $949.44 / $1,526.97	Facility	26	$949.44	$949.44	$1,526.97
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $239.32 / $361.51 / $487.80	Professional		$239.32	$361.51	$487.80
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $91.72 / $114.18 / $154.84	Professional	26	$91.72	$114.18	$154.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $199.95 / $248.50 / $331.48	Professional	TC	$199.95	$248.50	$331.48
United Facility/Professional Professional Modifier Low / Median / High Price $155.22 / $191.74 / $492.04	Professional		$155.22	$191.74	$492.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.23 / $62.50 / $156.74	Professional	26	$51.23	$62.50	$156.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.86 / $128.46 / $325.48	Professional	TC	$102.86	$128.46	$325.48