Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $168.68 / $468.81 / $1,153.07	Professional		$168.68	$468.81	$1,153.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.84 / $64.92 / $178.30	Professional	26	$38.84	$64.92	$178.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.66 / $403.88 / $849.46	Professional	TC	$120.66	$403.88	$849.46
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.67 / $32.83 / $104.28	Professional	26	$30.67	$32.83	$104.28
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $243.03 / $283.08 / $283.08	Facility	26	$243.03	$283.08	$283.08
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $429.47 / $955.91 / $3,422.03	Professional		$429.47	$955.91	$3,422.03
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $85.01 / $152.96 / $504.45	Professional	26	$85.01	$152.96	$504.45
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $272.85 / $821.32 / $2,917.58	Professional	TC	$272.85	$821.32	$2,917.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.61 / $430.71 / $556.54	Professional		$102.61	$430.71	$556.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.29 / $67.14 / $93.99	Professional	26	$32.29	$67.14	$93.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $71.42 / $364.32 / $462.55	Professional	TC	$71.42	$364.32	$462.55
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $60.76 / $122.35 / $186.56	Facility	26	$60.76	$122.35	$186.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $319.44 / $634.38 / $1,176.47	Professional		$319.44	$634.38	$1,176.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $78.93 / $123.98 / $170.64	Professional	26	$78.93	$123.98	$170.64
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $222.81 / $533.01 / $1,000.71	Professional	TC	$222.81	$533.01	$1,000.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $48.70 / $425.90 / $937.12	Professional		$48.70	$425.90	$937.12
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $101.75 / $123.95 / $125.29	Facility	26	$101.75	$123.95	$125.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $74.40 / $95.62 / $127.05	Professional	26	$74.40	$95.62	$127.05
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $389.60 / $550.54 / $694.64	Professional	TC	$389.60	$550.54	$694.64
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $547.28 / $932.40 / $1,084.63	Professional		$547.28	$932.40	$1,084.63
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $86.28 / $145.21 / $169.90	Professional	26	$86.28	$145.21	$169.90
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $461.55 / $786.34 / $914.73	Professional	TC	$461.55	$786.34	$914.73
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $384.22 / $744.03 / $980.23	Professional		$384.22	$744.03	$980.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $85.01 / $116.55 / $152.96	Professional	26	$85.01	$116.55	$152.96
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $285.69 / $627.48 / $826.68	Professional	TC	$285.69	$627.48	$826.68
United Facility/Professional Professional Modifier Low / Median / High Price $240.13 / $247.27 / $840.11	Professional		$240.13	$247.27	$840.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.50 / $57.37 / $105.06	Professional	26	$40.50	$57.37	$105.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $202.51 / $207.31 / $702.42	Professional	TC	$202.51	$207.31	$702.42