Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.12 / $121.33 / $203.79	Professional		$96.12	$121.33	$203.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.88 / $91.39 / $120.19	Professional	26	$73.88	$91.39	$120.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.55 / $30.64 / $54.33	Professional	TC	$20.55	$30.64	$54.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.97 / $192.03 / $212.69	Professional		$114.97	$192.03	$212.69
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $103.28 / $177.91 / $343.65	Facility	26	$103.28	$177.91	$343.65
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $110.40 / $226.59 / $897.38	Professional		$110.40	$226.59	$897.38
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.31 / $158.01 / $625.42	Professional	26	$78.31	$158.01	$625.42
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $62.39 / $62.39 / $62.39	Professional	52	$62.39	$62.39	$62.39
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.37 / $65.23 / $271.95	Professional	TC	$31.37	$65.23	$271.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.94 / $166.18 / $324.10	Professional		$92.94	$166.18	$324.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.45 / $124.03 / $229.32	Professional	26	$76.45	$124.03	$229.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.86 / $39.57 / $95.92	Professional	TC	$19.86	$39.57	$95.92
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $73.28 / $111.80 / $198.99	Facility	26	$73.28	$111.80	$198.99
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.04 / $145.13 / $257.35	Professional		$95.04	$145.13	$257.35
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $73.28 / $112.99 / $198.08	Professional	26	$73.28	$112.99	$198.08
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.39 / $33.89 / $63.66	Professional	TC	$20.39	$33.89	$63.66
Molina Facility/Professional Professional Modifier Low / Median / High Price $24.53 / $105.88 / $301.37	Professional		$24.53	$105.88	$301.37
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $113.19 / $150.91 / $152.09	Facility	26	$113.19	$150.91	$152.09
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $92.66 / $114.07 / $151.41	Professional	26	$92.66	$114.07	$151.41
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.20 / $36.11 / $57.24	Professional	TC	$26.20	$36.11	$57.24
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $103.28 / $103.28 / $103.28	Facility	26	$103.28	$103.28	$103.28
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $168.26 / $251.97 / $295.07	Professional		$168.26	$251.97	$295.07
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $118.97 / $178.74 / $208.55	Professional	26	$118.97	$178.74	$208.55
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $48.90 / $73.78 / $86.52	Professional	TC	$48.90	$73.78	$86.52
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $104.88 / $112.82 / $215.95	Professional		$104.88	$112.82	$215.95
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $74.40 / $78.66 / $152.63	Professional	26	$74.40	$78.66	$152.63
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $30.49 / $34.15 / $63.32	Professional	TC	$30.49	$34.15	$63.32
United Facility/Professional Professional Modifier Low / Median / High Price $101.57 / $152.00 / $299.24	Professional		$101.57	$152.00	$299.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.43 / $115.26 / $221.10	Professional	26	$73.43	$115.26	$221.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.38 / $40.15 / $86.60	Professional	TC	$24.38	$40.15	$86.60