Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.37 / $207.96 / $330.76	Facility	26	$105.37	$207.96	$330.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $126.26 / $171.37 / $342.74	Professional		$126.26	$171.37	$342.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $45.58 / $66.00 / $132.00	Professional	TC	$45.58	$66.00	$132.00
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $125.03 / $425.13 / $484.26	Facility	26	$125.03	$425.13	$484.26
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $200.05 / $345.01 / $1,230.75	Professional		$200.05	$345.01	$1,230.75
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.53 / $122.46 / $585.04	Professional	TC	$72.53	$122.46	$585.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $179.86 / $299.37 / $453.84	Professional		$179.86	$299.37	$453.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.23 / $111.90 / $178.92	Professional	TC	$62.23	$111.90	$178.92
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $89.59 / $211.48 / $747.49	Facility	26	$89.59	$211.48	$747.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.61 / $315.49 / $419.36	Professional		$138.61	$315.49	$419.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.31 / $106.37 / $166.88	Professional	TC	$51.31	$106.37	$166.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.84 / $148.90 / $290.85	Professional		$27.84	$148.90	$290.85
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $147.00 / $182.13 / $187.68	Facility	26	$147.00	$182.13	$187.68
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $67.62 / $67.62 / $95.06	Professional		$67.62	$67.62	$95.06
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $66.86 / $87.04 / $114.92	Professional	TC	$66.86	$87.04	$114.92
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $125.03 / $125.03 / $125.68	Facility	26	$125.03	$125.03	$125.68
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $225.00 / $333.27 / $404.35	Professional		$225.00	$333.27	$404.35
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $82.19 / $122.73 / $146.04	Professional	TC	$82.19	$122.73	$146.04
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $484.26 / $484.26 / $803.73	Facility	26	$484.26	$484.26	$803.73
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $200.05 / $298.66 / $391.62	Professional		$200.05	$298.66	$391.62
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $72.53 / $110.29 / $144.61	Professional	TC	$72.53	$110.29	$144.61
United Facility/Professional Professional Modifier Low / Median / High Price $129.76 / $159.49 / $379.41	Professional		$129.76	$159.49	$379.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.17 / $57.94 / $138.59	Professional	TC	$44.17	$57.94	$138.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $159.88 / $159.88 / $159.88	Professional		$159.88	$159.88	$159.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $63.30 / $63.30 / $63.30	Professional	TC	$63.30	$63.30	$63.30