Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.21 / $96.91 / $215.16	Professional		$53.21	$96.91	$215.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.93 / $68.98 / $338.69	Professional	26	$25.93	$68.98	$338.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.46 / $73.23 / $215.97	Professional	TC	$29.46	$73.23	$215.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $48.27 / $48.27 / $54.33	Professional		$48.27	$48.27	$54.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.46 / $37.11 / $53.82	Professional	26	$13.46	$37.11	$53.82
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $235.04 / $437.49 / $437.49	Facility		$235.04	$437.49	$437.49
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $71.22 / $124.11 / $124.11	Facility	26	$71.22	$124.11	$124.11
Asuris Northwest Health Facility/Professional Facility Modifier TC Low / Median / High Price $168.30 / $313.37 / $313.37	Facility	TC	$168.30	$313.37	$313.37
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $108.53 / $210.53 / $778.88	Professional		$108.53	$210.53	$778.88
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.69 / $66.45 / $222.90	Professional	26	$36.69	$66.45	$222.90
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.95 / $145.86 / $555.98	Professional	TC	$72.95	$145.86	$555.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.40 / $98.05 / $133.28	Professional		$32.40	$98.05	$133.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.70 / $29.47 / $39.65	Professional	26	$10.70	$29.47	$39.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.01 / $68.30 / $91.31	Professional	TC	$22.01	$68.30	$91.31
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $90.72 / $141.19 / $264.52	Facility		$90.72	$141.19	$264.52
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $27.28 / $44.22 / $80.51	Facility	26	$27.28	$44.22	$80.51
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $61.44 / $96.96 / $184.72	Facility	TC	$61.44	$96.96	$184.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $91.45 / $165.90 / $264.52	Professional		$91.45	$165.90	$264.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.28 / $50.56 / $80.51	Professional	26	$29.28	$50.56	$80.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $63.86 / $115.34 / $184.72	Professional	TC	$63.86	$115.34	$184.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.20 / $98.43 / $230.13	Professional		$19.20	$98.43	$230.13
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $124.52 / $174.87 / $182.24	Facility		$124.52	$174.87	$182.24
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $44.55 / $54.27 / $55.61	Facility	26	$44.55	$54.27	$55.61
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $99.18 / $119.93 / $127.97	Facility	TC	$99.18	$119.93	$127.97
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.96 / $44.55 / $57.27	Professional	26	$32.96	$44.55	$57.27
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $75.33 / $105.05 / $127.97	Professional	TC	$75.33	$105.05	$127.97
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.22 / $203.88 / $238.23	Professional		$123.22	$203.88	$238.23
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.82 / $63.78 / $75.31	Professional	26	$37.82	$63.78	$75.31
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $86.52 / $138.83 / $165.61	Professional	TC	$86.52	$138.83	$165.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $108.53 / $161.91 / $213.31	Professional		$108.53	$161.91	$213.31
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $34.77 / $51.66 / $67.80	Professional	26	$34.77	$51.66	$67.80
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $76.20 / $111.83 / $147.83	Professional	TC	$76.20	$111.83	$147.83
United Facility/Professional Professional Modifier Low / Median / High Price $52.25 / $69.69 / $185.63	Professional		$52.25	$69.69	$185.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.67 / $26.52 / $60.37	Professional	26	$16.67	$26.52	$60.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.38 / $38.76 / $100.56	Professional	TC	$37.38	$38.76	$100.56