Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.06 / $141.18 / $266.95	Professional		$76.06	$141.18	$266.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.09 / $21.49 / $45.07	Professional	26	$15.09	$21.49	$45.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.11 / $119.69 / $221.63	Professional	TC	$60.11	$119.69	$221.63
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $129.29 / $279.24 / $1,025.78	Professional		$129.29	$279.24	$1,025.78
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.33 / $44.77 / $205.00	Professional	26	$26.33	$44.77	$205.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $90.05 / $229.88 / $865.80	Professional	TC	$90.05	$229.88	$865.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $90.58 / $171.16 / $385.84	Professional		$90.58	$171.16	$385.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.36 / $33.90 / $57.68	Professional	26	$18.36	$33.90	$57.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.36 / $137.94 / $325.41	Professional	TC	$69.36	$137.94	$325.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $91.45 / $171.10 / $307.83	Professional		$91.45	$171.10	$307.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.05 / $36.97 / $48.87	Professional	26	$17.05	$36.97	$48.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $71.34 / $133.80 / $259.82	Professional	TC	$71.34	$133.80	$259.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.45 / $163.00 / $277.62	Professional		$27.45	$163.00	$277.62
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $32.35 / $40.47	Professional	26	$22.91	$32.35	$40.47
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $78.66 / $117.00 / $198.99	Professional	TC	$78.66	$117.00	$198.99
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $171.78 / $269.85 / $331.80	Professional		$171.78	$269.85	$331.80
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.38 / $44.12 / $54.25	Professional	26	$29.38	$44.12	$54.25
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $142.46 / $226.40 / $278.38	Professional	TC	$142.46	$226.40	$278.38
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $160.78 / $240.96 / $317.95	Professional		$160.78	$240.96	$317.95
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $27.36 / $39.15 / $53.23	Professional	26	$27.36	$39.15	$53.23
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $134.44 / $196.20 / $274.02	Professional	TC	$134.44	$196.20	$274.02
United Facility/Professional Professional Modifier Low / Median / High Price $80.86 / $131.21 / $320.91	Professional		$80.86	$131.21	$320.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.35 / $22.10 / $53.37	Professional	26	$19.35	$22.10	$53.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.86 / $100.03 / $255.51	Professional	TC	$60.86	$100.03	$255.51
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $127.30 / $127.30 / $127.30	Professional		$127.30	$127.30	$127.30
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $19.69 / $19.69 / $19.69	Professional	26	$19.69	$19.69	$19.69
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $107.61 / $107.61 / $107.61	Professional	TC	$107.61	$107.61	$107.61