Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $502.42 / $631.33 / $915.65	Professional		$502.42	$631.33	$915.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.70 / $43.37 / $85.35	Professional	26	$40.70	$43.37	$85.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $344.05 / $459.05 / $830.30	Professional	TC	$344.05	$459.05	$830.30
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $137.47 / $255.86 / $255.86	Facility	26	$137.47	$255.86	$255.86
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $787.77 / $1,426.85 / $5,038.05	Professional		$787.77	$1,426.85	$5,038.05
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.09 / $135.24 / $461.25	Professional	26	$76.09	$135.24	$461.25
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $607.80 / $1,289.01 / $4,576.88	Professional	TC	$607.80	$1,289.01	$4,576.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $328.07 / $634.21 / $860.61	Professional		$328.07	$634.21	$860.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.39 / $60.25 / $82.19	Professional	26	$30.39	$60.25	$82.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $297.68 / $576.40 / $776.26	Professional	TC	$297.68	$576.40	$776.26
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $55.49 / $111.16 / $171.56	Facility	26	$55.49	$111.16	$171.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $702.76 / $1,249.98 / $1,824.76	Professional		$702.76	$1,249.98	$1,824.76
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $71.72 / $112.46 / $156.91	Professional	26	$71.72	$112.46	$156.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $621.98 / $1,137.52 / $1,667.83	Professional	TC	$621.98	$1,137.52	$1,667.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $49.19 / $663.02 / $1,433.41	Professional		$49.19	$663.02	$1,433.41
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $92.40 / $112.31 / $113.56	Facility	26	$92.40	$112.31	$113.56
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $56.67 / $80.91 / $112.31	Professional	26	$56.67	$80.91	$112.31
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $534.20 / $800.42 / $995.53	Professional	TC	$534.20	$800.42	$995.53
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $814.28 / $1,369.29 / $1,629.96	Professional		$814.28	$1,369.29	$1,629.96
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $78.31 / $131.08 / $155.21	Professional	26	$78.31	$131.08	$155.21
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $736.48 / $1,237.01 / $1,472.50	Professional	TC	$736.48	$1,237.01	$1,472.50
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $841.76 / $1,122.66 / $1,479.06	Professional		$841.76	$1,122.66	$1,479.06
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $106.47 / $138.08	Professional	26	$77.62	$106.47	$138.08
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $764.15 / $1,017.21 / $1,338.79	Professional	TC	$764.15	$1,017.21	$1,338.79
United Facility/Professional Professional Modifier Low / Median / High Price $353.60 / $495.20 / $917.41	Professional		$353.60	$495.20	$917.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.36 / $36.15 / $122.07	Professional	26	$34.36	$36.15	$122.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $317.44 / $438.42 / $823.59	Professional	TC	$317.44	$438.42	$823.59