Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.98 / $101.46 / $241.75	Professional		$83.98	$101.46	$241.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.03 / $71.02 / $192.02	Professional	26	$48.03	$71.02	$192.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.96 / $37.85 / $89.53	Professional	TC	$35.96	$37.85	$89.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.39 / $49.96 / $108.00	Professional	26	$29.39	$49.96	$108.00
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $145.58 / $270.97 / $270.97	Facility	26	$145.58	$270.97	$270.97
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $120.18 / $224.82 / $771.00	Professional		$120.18	$224.82	$771.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $82.24 / $148.00 / $490.35	Professional	26	$82.24	$148.00	$490.35
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.24 / $78.77 / $280.64	Professional	TC	$42.24	$78.77	$280.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.02 / $94.47 / $135.29	Professional		$46.02	$94.47	$135.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.44 / $64.97 / $92.01	Professional	26	$32.44	$64.97	$92.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.72 / $33.15 / $47.91	Professional	TC	$12.72	$33.15	$47.91
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $61.07 / $121.69 / $183.75	Facility	26	$61.07	$121.69	$183.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $108.64 / $210.70 / $267.02	Professional		$108.64	$210.70	$267.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $78.51 / $123.98 / $168.07	Professional	26	$78.51	$123.98	$168.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.15 / $63.04 / $100.33	Professional	TC	$36.15	$63.04	$100.33
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 26 Low / Median / High Price $97.90 / $118.92 / $121.72	Facility	26	$97.90	$118.92	$121.72
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $74.00 / $93.60 / $121.27	Professional	26	$74.00	$93.60	$121.27
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $36.94 / $48.84 / $66.22	Professional	TC	$36.94	$48.84	$66.22
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $127.93 / $215.75 / $253.48	Professional		$127.93	$215.75	$253.48
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $83.41 / $140.16 / $165.31	Professional	26	$83.41	$140.16	$165.31
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.49 / $75.59 / $88.17	Professional	TC	$44.49	$75.59	$88.17
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $126.13 / $173.88 / $228.20	Professional		$126.13	$173.88	$228.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $82.24 / $113.40 / $148.00	Professional	26	$82.24	$113.40	$148.00
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $43.89 / $62.44 / $79.68	Professional	TC	$43.89	$62.44	$79.68
United Facility/Professional Professional Modifier Low / Median / High Price $55.22 / $92.03 / $199.36	Professional		$55.22	$92.03	$199.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.19 / $55.53 / $130.02	Professional	26	$39.19	$55.53	$130.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.03 / $19.52 / $41.58	Professional	TC	$16.03	$19.52	$41.58