Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.78 / $52.62 / $77.81	Professional		$50.78	$52.62	$77.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.87 / $26.25 / $88.58	Professional	26	$19.87	$26.25	$88.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.76 / $51.56 / $76.48	Professional	TC	$32.76	$51.56	$76.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.93 / $20.93 / $20.93	Professional	26	$20.93	$20.93	$20.93
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $49.91 / $49.91 / $49.91	Professional	TC	$49.91	$49.91	$49.91
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $113.54 / $113.54	Facility	26	$100.00	$113.54	$113.54
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $90.70 / $181.47 / $686.78	Professional		$90.70	$181.47	$686.78
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.19 / $61.99 / $204.00	Professional	26	$34.19	$61.99	$204.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.14 / $123.67 / $482.78	Professional	TC	$58.14	$123.67	$482.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.04 / $81.95 / $103.12	Professional		$32.04	$81.95	$103.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.38 / $27.09 / $37.92	Professional	26	$13.38	$27.09	$37.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.78 / $55.04 / $73.44	Professional	TC	$14.78	$55.04	$73.44
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $25.11 / $49.99 / $72.63	Facility	26	$25.11	$49.99	$72.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $72.86 / $136.16 / $206.24	Professional		$72.86	$136.16	$206.24
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.25 / $50.81 / $70.31	Professional	26	$32.25	$50.81	$70.31
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $44.80 / $86.17 / $135.68	Professional	TC	$44.80	$86.17	$135.68
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 $37.24 / $49.58 / $50.92	Facility	26	$37.24	$49.58	$50.92
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $31.20 / $43.32 / $50.92	Professional	26	$31.20	$43.32	$50.92
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $44.00 / $59.96 / $98.28	Professional	TC	$44.00	$59.96	$98.28
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.27 / $169.05 / $205.72	Professional		$108.27	$169.05	$205.72
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.76 / $58.08 / $68.88	Professional	26	$34.76	$58.08	$68.88
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.18 / $109.48 / $138.22	Professional	TC	$72.18	$109.48	$138.22
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $97.02 / $139.93 / $181.47	Professional		$97.02	$139.93	$181.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $34.19 / $47.25 / $61.18	Professional	26	$34.19	$47.25	$61.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $62.83 / $93.87 / $116.74	Professional	TC	$62.83	$93.87	$116.74
United Facility/Professional Professional Modifier Low / Median / High Price $43.52 / $51.62 / $148.00	Professional		$43.52	$51.62	$148.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.26 / $16.32 / $42.14	Professional	26	$15.26	$16.32	$42.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.28 / $30.29 / $92.77	Professional	TC	$27.28	$30.29	$92.77