Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.84 / $50.62 / $84.53	Facility	26	$25.84	$50.62	$84.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.12 / $171.46 / $342.92	Professional		$98.12	$171.46	$342.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.93 / $145.61 / $291.22	Professional	TC	$78.93	$145.61	$291.22
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $104.46 / $104.46	Facility	26	$100.00	$104.46	$104.46
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $185.94 / $340.85 / $1,229.70	Professional		$185.94	$340.85	$1,229.70
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $144.52 / $277.20 / $1,041.68	Professional	TC	$144.52	$277.20	$1,041.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $118.29 / $222.01 / $463.30	Professional		$118.29	$222.01	$463.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.53 / $178.16 / $390.95	Professional	TC	$93.53	$178.16	$390.95
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $22.94 / $51.54 / $490.69	Facility	26	$22.94	$51.54	$490.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $110.45 / $235.72 / $373.77	Professional		$110.45	$235.72	$373.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $87.29 / $181.94 / $313.83	Professional	TC	$87.29	$181.94	$313.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.51 / $187.85 / $335.43	Professional		$32.51	$187.85	$335.43
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.77 / $45.56 / $46.90	Facility	26	$35.77	$45.56	$46.90
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $117.30 / $140.29 / $183.23	Professional		$117.30	$140.29	$183.23
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $110.48 / $155.44 / $239.21	Professional	TC	$110.48	$155.44	$239.21
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $30.80 / $30.80 / $31.08	Facility	26	$30.80	$30.80	$31.08
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $209.06 / $323.98 / $398.35	Professional		$209.06	$323.98	$398.35
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $175.61 / $272.14 / $334.62	Professional	TC	$175.61	$272.14	$334.62
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $346.39 / $851.78	Facility	26	$346.39	$346.39	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $197.27 / $288.79 / $385.13	Professional		$197.27	$288.79	$385.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $165.86 / $239.92 / $333.40	Professional	TC	$165.86	$239.92	$333.40
United Facility/Professional Professional Modifier Low / Median / High Price $116.07 / $158.41 / $387.47	Professional		$116.07	$158.41	$387.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.08 / $126.25 / $325.48	Professional	TC	$89.08	$126.25	$325.48
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $161.28 / $161.28 / $161.28	Professional		$161.28	$161.28	$161.28
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $137.09 / $137.09 / $137.09	Professional	TC	$137.09	$137.09	$137.09