Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $92.16 / $226.45 / $308.80	Professional		$92.16	$226.45	$308.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.18 / $24.92 / $135.44	Professional	26	$19.18	$24.92	$135.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.77 / $201.53 / $376.71	Professional	TC	$79.77	$201.53	$376.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.84 / $11.84 / $11.84	Professional	26	$11.84	$11.84	$11.84
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $90.94 / $240.51 / $240.51	Facility	26	$90.94	$240.51	$240.51
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $211.70 / $485.33 / $1,751.03	Professional		$211.70	$485.33	$1,751.03
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.88 / $61.93 / $315.72	Professional	26	$31.88	$61.93	$315.72
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $196.43 / $439.79 / $1,565.18	Professional	TC	$196.43	$439.79	$1,565.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.95 / $208.12 / $265.70	Professional		$62.95	$208.12	$265.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.13 / $26.55 / $50.42	Professional	26	$13.13	$26.55	$50.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.82 / $165.82 / $238.90	Professional	TC	$49.82	$165.82	$238.90
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $30.98 / $60.40 / $101.62	Facility	26	$30.98	$60.40	$101.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $148.54 / $306.89 / $542.72	Professional		$148.54	$306.89	$542.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.17 / $60.40 / $92.61	Professional	26	$37.17	$60.40	$92.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $117.55 / $229.21 / $486.63	Professional	TC	$117.55	$229.21	$486.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.16 / $220.85 / $494.90	Professional		$40.16	$220.85	$494.90
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $37.39 / $45.19 / $76.93	Facility	26	$37.39	$45.19	$76.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.54 / $55.57 / $102.00	Professional	26	$28.54	$55.57	$102.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $135.68 / $180.95 / $412.80	Professional	TC	$135.68	$180.95	$412.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $273.61 / $460.74 / $552.88	Professional		$273.61	$460.74	$552.88
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.97 / $54.48 / $63.74	Professional	26	$31.97	$54.48	$63.74
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $242.81 / $405.01 / $489.51	Professional	TC	$242.81	$405.01	$489.51
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $241.00 / $379.26 / $485.33	Professional		$241.00	$379.26	$485.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $31.88 / $44.24 / $58.70	Professional	26	$31.88	$44.24	$58.70
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $213.86 / $335.79 / $426.63	Professional	TC	$213.86	$335.79	$426.63
United Facility/Professional Professional Modifier Low / Median / High Price $109.78 / $182.97 / $423.58	Professional		$109.78	$182.97	$423.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.59 / $15.59 / $49.83	Professional	26	$15.59	$15.59	$49.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $94.19 / $108.37 / $244.38	Professional	TC	$94.19	$108.37	$244.38