Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.76 / $58.81 / $165.18	Professional		$48.76	$58.81	$165.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.98 / $27.90 / $84.15	Professional	26	$21.98	$27.90	$84.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.83 / $44.51 / $95.32	Professional	TC	$36.83	$44.51	$95.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.29 / $47.26 / $52.98	Professional	26	$13.29	$47.26	$52.98
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $122.62 / $122.62	Facility	26	$100.00	$122.62	$122.62
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $91.01 / $170.01 / $650.33	Professional		$91.01	$170.01	$650.33
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.50 / $65.31 / $219.98	Professional	26	$36.50	$65.31	$219.98
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.52 / $105.85 / $430.35	Professional	TC	$54.52	$105.85	$430.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.31 / $77.73 / $100.58	Professional		$37.31	$77.73	$100.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.88 / $29.18 / $39.44	Professional	26	$14.88	$29.18	$39.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.64 / $49.88 / $65.40	Professional	TC	$18.64	$49.88	$65.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $27.28 / $54.59 / $80.62	Facility	26	$27.28	$54.59	$80.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $86.59 / $153.11 / $204.08	Professional		$86.59	$153.11	$204.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.22 / $56.91 / $73.73	Professional	26	$35.22	$56.91	$73.73
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.99 / $96.20 / $126.43	Professional	TC	$46.99	$96.20	$126.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.22 / $98.84 / $230.42	Professional		$19.22	$98.84	$230.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $41.16 / $53.60 / $56.28	Facility	26	$41.16	$53.60	$56.28
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.96 / $50.65 / $63.20	Professional	26	$32.96	$50.65	$63.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $50.25 / $71.36 / $98.49	Professional	TC	$50.25	$71.36	$98.49
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.83 / $158.59 / $190.16	Professional		$102.83	$158.59	$190.16
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.35 / $62.01 / $72.55	Professional	26	$37.35	$62.01	$72.55
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $65.47 / $94.99 / $123.14	Professional	TC	$65.47	$94.99	$123.14
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $91.01 / $132.61 / $170.01	Professional		$91.01	$132.61	$170.01
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $36.50 / $49.77 / $65.31	Professional	26	$36.50	$49.77	$65.31
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $54.52 / $80.01 / $104.00	Professional	TC	$54.52	$80.01	$104.00
United Facility/Professional Professional Modifier Low / Median / High Price $41.79 / $45.97 / $142.10	Professional		$41.79	$45.97	$142.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.07 / $18.64 / $45.50	Professional	26	$16.07	$18.64	$45.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.25 / $27.92 / $62.92	Professional	TC	$24.25	$27.92	$62.92