Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.35 / $60.31 / $145.81	Professional		$51.35	$60.31	$145.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.37 / $43.12 / $234.28	Professional	26	$29.37	$43.12	$234.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.54 / $21.99 / $54.62	Professional	TC	$21.54	$21.99	$54.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.91 / $19.36 / $60.88	Professional	26	$17.91	$19.36	$60.88
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $88.48 / $165.02 / $165.02	Facility	26	$88.48	$165.02	$165.02
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $74.33 / $135.60 / $466.05	Professional		$74.33	$135.60	$466.05
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.90 / $90.47 / $297.23	Professional	26	$49.90	$90.47	$297.23
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.23 / $47.47 / $168.83	Professional	TC	$24.23	$47.47	$168.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.53 / $58.60 / $82.05	Professional		$28.53	$58.60	$82.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.23 / $39.44 / $56.11	Professional	26	$19.23	$39.44	$56.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $8.19 / $20.07 / $29.11	Professional	TC	$8.19	$20.07	$29.11
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $47.95 / $74.33 / $99.49	Facility	26	$47.95	$74.33	$99.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $67.47 / $128.86 / $162.06	Professional		$67.47	$128.86	$162.06
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.95 / $76.55 / $102.04	Professional	26	$47.95	$76.55	$102.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $40.50 / $63.99	Professional	TC	$22.91	$40.50	$63.99
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.79 / $63.88 / $148.14	Professional		$10.79	$63.88	$148.14
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $54.75 / $72.36 / $75.70	Facility	26	$54.75	$72.36	$75.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.22 / $64.69 / $87.20	Professional	26	$44.22	$64.69	$87.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.11 / $31.83 / $44.00	Professional	TC	$22.11	$31.83	$44.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.51 / $128.72 / $153.37	Professional		$77.51	$128.72	$153.37
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.51 / $85.04 / $100.11	Professional	26	$50.51	$85.04	$100.11
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.08 / $43.46 / $53.27	Professional	TC	$27.08	$43.46	$53.27
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $75.77 / $106.59 / $135.60	Professional		$75.77	$106.59	$135.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.90 / $68.67 / $90.12	Professional	26	$49.90	$68.67	$90.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $25.87 / $37.72 / $48.14	Professional	TC	$25.87	$37.72	$48.14
United Facility/Professional Professional Modifier Low / Median / High Price $33.95 / $49.08 / $117.80	Professional		$33.95	$49.08	$117.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.16 / $23.82 / $61.80	Professional	26	$22.16	$23.82	$61.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.82 / $18.04 / $41.76	Professional	TC	$10.82	$18.04	$41.76