Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.50 / $110.91 / $397.29	Professional		$79.50	$110.91	$397.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.37 / $140.32 / $755.41	Professional	26	$58.37	$140.32	$755.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.59 / $47.25 / $91.68	Professional	TC	$31.59	$47.25	$91.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.99 / $108.77 / $161.80	Professional	26	$31.99	$108.77	$161.80
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $246.39 / $457.19 / $457.19	Facility		$246.39	$457.19	$457.19
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $146.41 / $272.47 / $272.47	Facility	26	$146.41	$272.47	$272.47
Asuris Northwest Health Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $184.67 / $184.67	Facility	TC	$100.00	$184.67	$184.67
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $131.09 / $248.04 / $855.68	Professional		$131.09	$248.04	$855.68
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $82.70 / $149.40 / $493.50	Professional	26	$82.70	$149.40	$493.50
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.39 / $101.74 / $362.18	Professional	TC	$48.39	$101.74	$362.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.54 / $103.35 / $149.86	Professional		$48.54	$103.35	$149.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.92 / $65.72 / $92.01	Professional	26	$31.92	$65.72	$92.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.89 / $42.85 / $55.26	Professional	TC	$15.89	$42.85	$55.26
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $91.45 / $154.08 / $323.43	Facility		$91.45	$154.08	$323.43
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $59.94 / $121.69 / $183.75	Facility	26	$59.94	$121.69	$183.75
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $32.54 / $61.92 / $138.75	Facility	TC	$32.54	$61.92	$138.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $93.62 / $182.86 / $270.80	Professional		$93.62	$182.86	$270.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.07 / $121.69 / $168.07	Professional	26	$61.07	$121.69	$168.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.34 / $61.92 / $112.18	Professional	TC	$35.34	$61.92	$112.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.47 / $89.88 / $219.93	Professional		$17.47	$89.88	$219.93
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $142.79 / $186.26 / $203.01	Facility		$142.79	$186.26	$203.01
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $98.45 / $119.57 / $121.72	Facility	26	$98.45	$119.57	$121.72
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $46.06 / $67.67 / $83.08	Facility	TC	$46.06	$67.67	$83.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $65.87 / $99.75 / $119.93	Professional	26	$65.87	$99.75	$119.93
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $36.40 / $53.06 / $80.40	Professional	TC	$36.40	$53.06	$80.40
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $140.41 / $235.47 / $278.27	Professional		$140.41	$235.47	$278.27
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $83.41 / $140.50 / $165.31	Professional	26	$83.41	$140.50	$165.31
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $56.17 / $94.97 / $112.96	Professional	TC	$56.17	$94.97	$112.96
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $138.13 / $189.50 / $248.04	Professional		$138.13	$189.50	$248.04
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $82.70 / $113.40 / $148.00	Professional	26	$82.70	$113.40	$148.00
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $55.44 / $77.48 / $100.04	Professional	TC	$55.44	$77.48	$100.04
United Facility/Professional Professional Modifier Low / Median / High Price $60.20 / $61.61 / $204.69	Professional		$60.20	$61.61	$204.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.19 / $55.52 / $130.02	Professional	26	$39.19	$55.52	$130.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.01 / $25.01 / $81.04	Professional	TC	$21.01	$25.01	$81.04