Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.83 / $310.48 / $464.25	Professional		$162.83	$310.48	$464.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.14 / $47.82 / $214.80	Professional	26	$33.14	$47.82	$214.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $129.68 / $346.06 / $772.00	Professional	TC	$129.68	$346.06	$772.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.15 / $21.16 / $113.88	Professional	26	$21.15	$21.16	$113.88
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $97.99 / $183.18 / $183.18	Facility	26	$97.99	$183.18	$183.18
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $362.00 / $750.32 / $2,491.19	Professional		$362.00	$750.32	$2,491.19
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.75 / $100.65 / $332.93	Professional	26	$57.75	$100.65	$332.93
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $281.70 / $650.13 / $2,158.28	Professional	TC	$281.70	$650.13	$2,158.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $98.23 / $313.80 / $431.49	Professional		$98.23	$313.80	$431.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.19 / $45.29 / $64.72	Professional	26	$22.19	$45.29	$64.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.76 / $271.93 / $371.85	Professional	TC	$76.76	$271.93	$371.85
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $41.85 / $84.19 / $125.62	Facility	26	$41.85	$84.19	$125.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $305.35 / $532.46 / $921.81	Professional		$305.35	$532.46	$921.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.32 / $85.36 / $114.90	Professional	26	$54.32	$85.36	$114.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $239.18 / $462.70 / $806.90	Professional	TC	$239.18	$462.70	$806.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $48.32 / $303.86 / $669.98	Professional		$48.32	$303.86	$669.98
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.54 / $80.58 / $85.76	Facility	26	$66.54	$80.58	$85.76
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $53.23 / $60.48 / $86.43	Professional	26	$53.23	$60.48	$86.43
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $347.76 / $402.90 / $554.76	Professional	TC	$347.76	$402.90	$554.76
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $402.93 / $679.53 / $867.49	Professional		$402.93	$679.53	$867.49
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.46 / $96.06 / $113.88	Professional	26	$57.46	$96.06	$113.88
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $345.97 / $583.46 / $744.85	Professional	TC	$345.97	$583.46	$744.85
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $344.34 / $565.36 / $750.32	Professional		$344.34	$565.36	$750.32
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.75 / $79.34 / $102.92	Professional	26	$57.75	$79.34	$102.92
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $286.56 / $487.13 / $647.40	Professional	TC	$286.56	$487.13	$647.40
United Facility/Professional Professional Modifier Low / Median / High Price $183.80 / $208.96 / $652.96	Professional		$183.80	$208.96	$652.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.21 / $27.72 / $69.76	Professional	26	$25.21	$27.72	$69.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.59 / $181.24 / $470.23	Professional	TC	$158.59	$181.24	$470.23