Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $178.89 / $261.63 / $534.85	Professional		$178.89	$261.63	$534.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.96 / $84.81 / $394.25	Professional	26	$21.96	$84.81	$394.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $179.03 / $231.69 / $422.75	Professional	TC	$179.03	$231.69	$422.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $143.54 / $143.54 / $143.54	Professional		$143.54	$143.54	$143.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $66.13 / $155.60	Professional	26	$38.90	$66.13	$155.60
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $702.73 / $1,301.88 / $1,301.88	Facility		$702.73	$1,301.88	$1,301.88
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $193.05 / $358.77 / $358.77	Facility	26	$193.05	$358.77	$358.77
Asuris Northwest Health Facility/Professional Facility Modifier TC Low / Median / High Price $509.68 / $943.11 / $943.11	Facility	TC	$509.68	$943.11	$943.11
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $362.34 / $687.90 / $2,483.55	Professional		$362.34	$687.90	$2,483.55
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $109.96 / $198.37 / $653.48	Professional	26	$109.96	$198.37	$653.48
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $250.17 / $517.21 / $1,830.08	Professional	TC	$250.17	$517.21	$1,830.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $135.97 / $296.81 / $430.37	Professional		$135.97	$296.81	$430.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.71 / $87.02 / $121.83	Professional	26	$42.71	$87.02	$121.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.69 / $216.75 / $312.45	Professional	TC	$72.69	$216.75	$312.45
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $273.42 / $497.29 / $927.23	Facility		$273.42	$497.29	$927.23
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $80.59 / $160.50 / $243.75	Facility	26	$80.59	$160.50	$243.75
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $182.68 / $347.52 / $705.93	Facility	TC	$182.68	$347.52	$705.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $296.73 / $597.54 / $774.20	Professional		$296.73	$597.54	$774.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $103.55 / $163.27 / $222.95	Professional	26	$103.55	$163.27	$222.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $198.71 / $422.85 / $571.96	Professional	TC	$198.71	$422.85	$571.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $51.87 / $265.01 / $672.32	Professional		$51.87	$265.01	$672.32
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $364.34 / $530.89 / $578.88	Facility		$364.34	$530.89	$578.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $130.31 / $157.37 / $162.52	Facility	26	$130.31	$157.37	$162.52
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $233.83 / $370.50 / $420.09	Facility	TC	$233.83	$370.50	$420.09
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $94.47 / $133.94 / $197.16	Professional	26	$94.47	$133.94	$197.16
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $217.08 / $324.89 / $480.60	Professional	TC	$217.08	$324.89	$480.60
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $400.38 / $653.04 / $793.50	Professional		$400.38	$653.04	$793.50
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $110.75 / $186.61 / $219.50	Professional	26	$110.75	$186.61	$219.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $284.02 / $469.81 / $574.00	Professional	TC	$284.02	$469.81	$574.00
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $388.08 / $544.32 / $687.90	Professional		$388.08	$544.32	$687.90
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $109.96 / $150.57 / $197.61	Professional	26	$109.96	$150.57	$197.61
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $278.12 / $393.75 / $490.29	Professional	TC	$278.12	$393.75	$490.29
United Facility/Professional Professional Modifier Low / Median / High Price $168.90 / $212.76 / $438.21	Professional		$168.90	$212.76	$438.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.59 / $52.42 / $134.84	Professional	26	$48.59	$52.42	$134.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.93 / $134.91 / $397.59	Professional	TC	$116.93	$134.91	$397.59