Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.51 / $69.39 / $116.34	Facility	26	$44.51	$69.39	$116.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.89 / $203.63 / $318.54	Professional		$107.89	$203.63	$318.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.03 / $48.52 / $102.85	Professional	26	$33.03	$48.52	$102.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.01 / $142.02 / $250.03	Professional	TC	$71.01	$142.02	$250.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.35 / $21.89 / $69.19	Professional	26	$20.35	$21.89	$69.19
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $57.08 / $239.31 / $239.31	Facility	26	$57.08	$239.31	$239.31
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $235.77 / $423.78 / $1,530.15	Professional		$235.77	$423.78	$1,530.15
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.21 / $99.84 / $339.98	Professional	26	$58.21	$99.84	$339.98
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $170.78 / $325.32 / $1,190.09	Professional	TC	$170.78	$325.32	$1,190.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.25 / $29.11 / $54.03	Facility	26	$27.25	$29.11	$54.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $90.03 / $186.26 / $234.35	Professional		$90.03	$186.26	$234.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.21 / $42.75 / $60.73	Professional	26	$23.21	$42.75	$60.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.92 / $141.09 / $181.99	Professional	TC	$60.92	$141.09	$181.99
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $53.01 / $95.50 / $142.99	Facility	26	$53.01	$95.50	$142.99
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $177.63 / $378.81 / $513.79	Professional		$177.63	$378.81	$513.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.01 / $95.54 / $135.09	Professional	26	$53.01	$95.54	$135.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $135.16 / $253.25 / $390.96	Professional	TC	$135.16	$253.25	$390.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $33.81 / $185.73 / $398.23	Professional		$33.81	$185.73	$398.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $68.19 / $82.51 / $104.15	Facility	26	$68.19	$82.51	$104.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $60.50 / $81.40 / $100.80	Professional	26	$60.50	$81.40	$100.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $143.55 / $201.78 / $272.69	Professional	TC	$143.55	$201.78	$272.69
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $56.17 / $56.17 / $57.08	Facility	26	$56.17	$56.17	$57.08
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $248.39 / $405.54 / $494.10	Professional		$248.39	$405.54	$494.10
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.93 / $94.53 / $114.80	Professional	26	$57.93	$94.53	$114.80
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.50 / $311.02 / $379.30	Professional	TC	$190.50	$311.02	$379.30
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $289.37 / $289.37 / $435.36	Facility	26	$289.37	$289.37	$435.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $243.94 / $346.05 / $446.54	Professional		$243.94	$346.05	$446.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $58.21 / $81.52 / $104.18	Professional	26	$58.21	$81.52	$104.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $185.72 / $267.44 / $342.79	Professional	TC	$185.72	$267.44	$342.79
United Facility/Professional Professional Modifier Low / Median / High Price $99.46 / $110.44 / $277.95	Professional		$99.46	$110.44	$277.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.42 / $27.50 / $69.20	Professional	26	$25.42	$27.50	$69.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.56 / $83.97 / $215.18	Professional	TC	$65.56	$83.97	$215.18