Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.73 / $106.32 / $276.30	Professional		$69.73	$106.32	$276.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.75 / $46.96 / $207.40	Professional	26	$25.75	$46.96	$207.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.21 / $65.36 / $130.18	Professional	TC	$50.21	$65.36	$130.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $59.52 / $59.52 / $238.08	Professional		$59.52	$59.52	$238.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.69 / $36.01 / $78.76	Professional	26	$19.69	$36.01	$78.76
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $159.30 / $159.30 / $159.30	Professional	TC	$159.30	$159.30	$159.30
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $290.76 / $540.45 / $540.45	Facility		$290.76	$540.45	$540.45
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $97.27 / $221.64 / $221.64	Facility	26	$97.27	$221.64	$221.64
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $163.12 / $292.51 / $1,031.84	Professional		$163.12	$292.51	$1,031.84
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.44 / $101.56 / $329.10	Professional	26	$55.44	$101.56	$329.10
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $99.02 / $193.88 / $702.75	Professional	TC	$99.02	$193.88	$702.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.19 / $130.71 / $183.00	Professional		$61.19	$130.71	$183.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.95 / $44.52 / $62.16	Professional	26	$25.95	$44.52	$62.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.15 / $88.35 / $120.84	Professional	TC	$35.15	$88.35	$120.84
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $131.44 / $251.27 / $384.37	Facility		$131.44	$251.27	$384.37
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $47.74 / $86.11 / $127.98	Facility	26	$47.74	$86.11	$127.98
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.12 / $255.41 / $351.57	Professional		$162.12	$255.41	$351.57
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.17 / $92.02 / $122.81	Professional	26	$55.17	$92.02	$122.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $92.40 / $165.76 / $238.38	Professional	TC	$92.40	$165.76	$238.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.62 / $104.68 / $297.07	Professional		$19.62	$104.68	$297.07
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $196.33 / $236.18 / $265.32	Facility		$196.33	$236.18	$265.32
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $65.98 / $80.40 / $102.51	Facility	26	$65.98	$80.40	$102.51
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $61.51 / $89.32 / $103.40	Professional	26	$61.51	$89.32	$103.40
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $94.87 / $138.60 / $189.60	Professional	TC	$94.87	$138.60	$189.60
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $171.15 / $279.24 / $323.27	Professional		$171.15	$279.24	$323.27
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.38 / $94.97 / $111.13	Professional	26	$62.38	$94.97	$111.13
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $109.40 / $183.25 / $212.15	Professional	TC	$109.40	$183.25	$212.15
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $163.55 / $221.76 / $292.16	Professional		$163.55	$221.76	$292.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $55.44 / $78.89 / $100.04	Professional	26	$55.44	$78.89	$100.04
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $108.11 / $145.53 / $191.73	Professional	TC	$108.11	$145.53	$191.73
United Facility/Professional Professional Modifier Low / Median / High Price $73.04 / $115.48 / $198.32	Professional		$73.04	$115.48	$198.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.42 / $33.94 / $68.54	Professional	26	$26.42	$33.94	$68.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.97 / $66.37 / $129.78	Professional	TC	$46.97	$66.37	$129.78