Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.70 / $117.93 / $245.31	Professional		$103.70	$117.93	$245.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.58 / $104.09 / $340.00	Professional	26	$53.58	$104.09	$340.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.34 / $95.67 / $183.03	Professional	TC	$64.34	$95.67	$183.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.26 / $100.26 / $165.05	Professional		$100.26	$100.26	$165.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.15 / $60.79 / $132.63	Professional	26	$33.15	$60.79	$132.63
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $420.88 / $778.10 / $778.10	Facility		$420.88	$778.10	$778.10
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $164.05 / $305.79 / $305.79	Facility	26	$164.05	$305.79	$305.79
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $193.32 / $355.47 / $1,961.76	Professional		$193.32	$355.47	$1,961.76
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.79 / $168.49 / $555.45	Professional	26	$93.79	$168.49	$555.45
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $98.54 / $224.79 / $876.98	Professional	TC	$98.54	$224.79	$876.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.51 / $171.87 / $222.90	Professional		$75.51	$171.87	$222.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.15 / $74.02 / $103.63	Professional	26	$36.15	$74.02	$103.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.31 / $102.68 / $133.61	Professional	TC	$34.31	$102.68	$133.61
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $137.63 / $237.62 / $420.69	Facility		$137.63	$237.62	$420.69
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $68.51 / $136.82 / $200.05	Facility	26	$68.51	$136.82	$200.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $187.58 / $300.81 / $434.89	Professional		$187.58	$300.81	$434.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $88.27 / $139.56 / $189.50	Professional	26	$88.27	$139.56	$189.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $90.28 / $161.24 / $253.17	Professional	TC	$90.28	$161.24	$253.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.99 / $152.59 / $359.49	Professional		$26.99	$152.59	$359.49
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $198.45 / $290.77 / $336.34	Facility		$198.45	$290.77	$336.34
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $111.08 / $134.29 / $138.69	Facility	26	$111.08	$134.29	$138.69
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $82.41 / $103.01 / $138.69	Professional	26	$82.41	$103.01	$138.69
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $91.80 / $120.36 / $153.93	Professional	TC	$91.80	$120.36	$153.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $227.41 / $371.11 / $441.75	Professional		$227.41	$371.11	$441.75
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $94.31 / $159.05 / $186.44	Professional	26	$94.31	$159.05	$186.44
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $131.66 / $207.69 / $255.32	Professional	TC	$131.66	$207.69	$255.32
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $212.98 / $299.70 / $388.55	Professional		$212.98	$299.70	$388.55
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $93.79 / $128.52 / $168.49	Professional	26	$93.79	$128.52	$168.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $119.20 / $175.14 / $215.82	Professional	TC	$119.20	$175.14	$215.82
United Facility/Professional Professional Modifier Low / Median / High Price $94.41 / $133.47 / $347.43	Professional		$94.41	$133.47	$347.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.39 / $46.16 / $115.16	Professional	26	$44.39	$46.16	$115.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.02 / $56.53 / $170.09	Professional	TC	$50.02	$56.53	$170.09