Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $62.92 / $87.07 / $234.21	Professional		$62.92	$87.07	$234.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.73 / $52.86 / $106.95	Professional	26	$28.73	$52.86	$106.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.27 / $57.67 / $120.74	Professional	TC	$35.27	$57.67	$120.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $63.51 / $112.47 / $224.94	Professional		$63.51	$112.47	$224.94
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.57 / $56.36 / $66.30	Professional	26	$16.57	$56.36	$66.30
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $274.69 / $510.17 / $510.17	Facility		$274.69	$510.17	$510.17
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $170.73 / $170.73	Facility	26	$100.00	$170.73	$170.73
Asuris Northwest Health Facility/Professional Facility Modifier TC Low / Median / High Price $192.68 / $357.27 / $357.27	Facility	TC	$192.68	$357.27	$357.27
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $133.38 / $247.64 / $910.50	Professional		$133.38	$247.64	$910.50
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.20 / $83.83 / $278.39	Professional	26	$46.20	$83.83	$278.39
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $80.80 / $165.34 / $632.92	Professional	TC	$80.80	$165.34	$632.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.50 / $114.38 / $154.68	Professional		$51.50	$114.38	$154.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.71 / $37.19 / $56.00	Professional	26	$18.71	$37.19	$56.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.03 / $75.04 / $100.94	Professional	TC	$27.03	$75.04	$100.94
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $105.71 / $205.23 / $325.31	Facility		$105.71	$205.23	$325.31
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $34.10 / $77.31 / $106.70	Facility	26	$34.10	$77.31	$106.70
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $67.27 / $147.01 / $228.92	Facility	TC	$67.27	$147.01	$228.92
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.26 / $230.43 / $310.25	Professional		$107.26	$230.43	$310.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.44 / $77.27 / $103.12	Professional	26	$38.44	$77.27	$103.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $73.16 / $147.01 / $211.62	Professional	TC	$73.16	$147.01	$211.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.40 / $100.42 / $286.05	Professional		$19.40	$100.42	$286.05
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $146.32 / $201.28 / $213.06	Facility		$146.32	$201.28	$213.06
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $55.54 / $67.15 / $69.68	Facility	26	$55.54	$67.15	$69.68
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $95.93 / $132.66 / $145.38	Facility	TC	$95.93	$132.66	$145.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $46.35 / $55.55 / $73.20	Professional	26	$46.35	$55.55	$73.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $86.43 / $101.91 / $132.66	Professional	TC	$86.43	$101.91	$132.66
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.05 / $236.40 / $273.68	Professional		$144.05	$236.40	$273.68
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.16 / $79.27 / $92.76	Professional	26	$47.16	$79.27	$92.76
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $98.30 / $156.28 / $181.78	Professional	TC	$98.30	$156.28	$181.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $136.75 / $187.74 / $247.34	Professional		$136.75	$187.74	$247.34
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $46.20 / $65.54 / $83.51	Professional	26	$46.20	$65.54	$83.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $86.58 / $127.05 / $167.84	Professional	TC	$86.58	$127.05	$167.84
United Facility/Professional Professional Modifier Low / Median / High Price $60.59 / $64.31 / $215.24	Professional		$60.59	$64.31	$215.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.09 / $31.29 / $57.30	Professional	26	$22.09	$31.29	$57.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.04 / $42.22 / $142.28	Professional	TC	$40.04	$42.22	$142.28