Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.53 / $159.59 / $230.00	Professional		$86.53	$159.59	$230.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.05 / $36.76 / $105.61	Professional	26	$17.05	$36.76	$105.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.49 / $122.83 / $179.63	Professional	TC	$51.49	$122.83	$179.63
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $58.00 / $58.00 / $58.00	Professional	26	$58.00	$58.00	$58.00
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $173.52 / $173.52	Facility	26	$100.00	$173.52	$173.52
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $165.38 / $364.58 / $1,294.95	Professional		$165.38	$364.58	$1,294.95
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.05 / $85.99 / $285.30	Professional	26	$48.05	$85.99	$285.30
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $86.09 / $276.60 / $1,009.65	Professional	TC	$86.09	$276.60	$1,009.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.18 / $154.74 / $197.40	Professional		$48.18	$154.74	$197.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.04 / $38.19 / $53.04	Professional	26	$19.04	$38.19	$53.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.07 / $96.90 / $154.30	Professional	TC	$28.07	$96.90	$154.30
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $38.13 / $69.06 / $105.93	Facility	26	$38.13	$69.06	$105.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $113.73 / $219.51 / $404.77	Professional		$113.73	$219.51	$404.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.56 / $79.38 / $99.53	Professional	26	$44.56	$79.38	$99.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $69.17 / $134.88 / $319.11	Professional	TC	$69.17	$134.88	$319.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.87 / $146.75 / $379.42	Professional		$27.87	$146.75	$379.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $57.19 / $69.17 / $74.70	Facility	26	$57.19	$69.17	$74.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $49.45 / $71.39 / $80.56	Professional	26	$49.45	$71.39	$80.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $82.11 / $106.20 / $231.73	Professional	TC	$82.11	$106.20	$231.73
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $203.85 / $337.19 / $416.04	Professional		$203.85	$337.19	$416.04
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.56 / $81.63 / $95.51	Professional	26	$48.56	$81.63	$95.51
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $156.74 / $259.26 / $320.52	Professional	TC	$156.74	$259.26	$320.52
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $179.55 / $279.02 / $348.30	Professional		$179.55	$279.02	$348.30
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $48.05 / $68.37 / $85.99	Professional	26	$48.05	$68.37	$85.99
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $120.15 / $215.75 / $267.80	Professional	TC	$120.15	$215.75	$267.80
United Facility/Professional Professional Modifier Low / Median / High Price $77.09 / $109.21 / $297.43	Professional		$77.09	$109.21	$297.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.52 / $33.64 / $75.11	Professional	26	$22.52	$33.64	$75.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.57 / $70.95 / $210.55	Professional	TC	$54.57	$70.95	$210.55