Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.52 / $134.22 / $362.48	Professional		$63.52	$134.22	$362.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.07 / $54.94 / $141.88	Professional	26	$37.07	$54.94	$141.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.49 / $89.94 / $275.80	Professional	TC	$49.49	$89.94	$275.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.89 / $21.89 / $21.89	Professional	26	$21.89	$21.89	$21.89
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $101.20 / $237.42 / $237.42	Facility	26	$101.20	$237.42	$237.42
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $162.16 / $292.16 / $1,020.60	Professional		$162.16	$292.16	$1,020.60
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.21 / $104.18 / $344.03	Professional	26	$58.21	$104.18	$344.03
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $104.87 / $187.54 / $676.58	Professional	TC	$104.87	$187.54	$676.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.68 / $137.72 / $189.06	Professional		$74.68	$137.72	$189.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.40 / $47.64 / $66.70	Professional	26	$27.40	$47.64	$66.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.44 / $87.50 / $122.37	Professional	TC	$47.44	$87.50	$122.37
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $52.08 / $92.10 / $139.83	Facility	26	$52.08	$92.10	$139.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $176.12 / $272.98 / $382.50	Professional		$176.12	$272.98	$382.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.56 / $96.24 / $130.91	Professional	26	$58.56	$96.24	$130.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $117.55 / $182.21 / $259.83	Professional	TC	$117.55	$182.21	$259.83
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 26 Low / Median / High Price $68.73 / $83.30 / $111.22	Facility	26	$68.73	$83.30	$111.22
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $63.30 / $96.60 / $119.85	Professional	26	$63.30	$96.60	$119.85
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $110.55 / $153.60 / $205.50	Professional	TC	$110.55	$153.60	$205.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $166.71 / $277.89 / $323.27	Professional		$166.71	$277.89	$323.27
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.85 / $98.90 / $116.64	Professional	26	$58.85	$98.90	$116.64
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $106.56 / $177.64 / $206.64	Professional	TC	$106.56	$177.64	$206.64
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $163.09 / $232.88 / $294.33	Professional		$163.09	$232.88	$294.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $58.21 / $82.83 / $105.41	Professional	26	$58.21	$82.83	$105.41
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $104.87 / $150.91 / $190.16	Professional	TC	$104.87	$150.91	$190.16
United Facility/Professional Professional Modifier Low / Median / High Price $77.52 / $112.24 / $299.10	Professional		$77.52	$112.24	$299.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.94 / $39.58 / $91.74	Professional	26	$27.94	$39.58	$91.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.74 / $53.27 / $162.50	Professional	TC	$45.74	$53.27	$162.50