Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.58 / $392.56 / $605.20	Professional		$67.58	$392.56	$605.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.13 / $29.70 / $60.48	Professional	26	$21.13	$29.70	$60.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.56 / $91.11 / $169.08	Professional	TC	$35.56	$91.11	$169.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.84 / $46.84 / $46.84	Professional	26	$46.84	$46.84	$46.84
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $68.33 / $127.16 / $127.16	Facility	26	$68.33	$127.16	$127.16
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $110.68 / $267.16 / $983.10	Professional		$110.68	$267.16	$983.10
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.95 / $67.62 / $230.85	Professional	26	$36.95	$67.62	$230.85
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.27 / $199.69 / $752.25	Professional	TC	$58.27	$199.69	$752.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.64 / $110.19 / $148.69	Professional		$34.64	$110.19	$148.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.05 / $30.51 / $41.96	Professional	26	$14.05	$30.51	$41.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.00 / $67.50 / $115.12	Professional	TC	$21.00	$67.50	$115.12
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $27.59 / $47.04 / $73.95	Facility	26	$27.59	$47.04	$73.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $87.42 / $138.21 / $309.26	Professional		$87.42	$138.21	$309.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.64 / $55.25 / $78.03	Professional	26	$35.64	$55.25	$78.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.77 / $84.01 / $240.28	Professional	TC	$51.77	$84.01	$240.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.20 / $104.27 / $296.23	Professional		$19.20	$104.27	$296.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $46.19 / $55.82 / $56.28	Facility	26	$46.19	$55.82	$56.28
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $39.27 / $47.88 / $56.28	Professional	26	$39.27	$47.88	$56.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $59.35 / $82.41 / $162.94	Professional	TC	$59.35	$82.41	$162.94
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.93 / $256.26 / $318.68	Professional		$154.93	$256.26	$318.68
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.93 / $65.93 / $77.15	Professional	26	$38.93	$65.93	$77.15
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $116.87 / $193.32 / $241.54	Professional	TC	$116.87	$193.32	$241.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $129.79 / $213.40 / $264.70	Professional		$129.79	$213.40	$264.70
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $38.81 / $52.92 / $69.45	Professional	26	$38.81	$52.92	$69.45
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $78.39 / $161.75 / $199.69	Professional	TC	$78.39	$161.75	$199.69
United Facility/Professional Professional Modifier Low / Median / High Price $56.51 / $94.19 / $218.05	Professional		$56.51	$94.19	$218.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $18.19 / $47.20	Professional	26	$17.07	$18.19	$47.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.32 / $53.47 / $130.31	Professional	TC	$38.32	$53.47	$130.31