Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.38 / $77.81 / $116.96	Professional		$47.38	$77.81	$116.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.98 / $25.86 / $37.38	Professional	26	$18.98	$25.86	$37.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.39 / $51.95 / $79.58	Professional	TC	$28.39	$51.95	$79.58
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $112.04 / $112.04	Facility	26	$100.00	$112.04	$112.04
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $88.20 / $182.43 / $701.33	Professional		$88.20	$182.43	$701.33
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.72 / $61.15 / $201.15	Professional	26	$33.72	$61.15	$201.15
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.88 / $122.96 / $500.25	Professional	TC	$52.88	$122.96	$500.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.47 / $83.68 / $105.36	Professional		$30.47	$83.68	$105.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.91 / $26.58 / $36.90	Professional	26	$12.91	$26.58	$36.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.11 / $50.82 / $76.12	Professional	TC	$15.11	$50.82	$76.12
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $23.87 / $48.01 / $75.93	Facility	26	$23.87	$48.01	$75.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $76.03 / $123.66 / $202.38	Professional		$76.03	$123.66	$202.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.98 / $48.78 / $69.04	Professional	26	$30.98	$48.78	$69.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.18 / $75.64 / $140.97	Professional	TC	$41.18	$75.64	$140.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.22 / $98.84 / $230.42	Professional		$19.22	$98.84	$230.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $47.57 / $48.91	Facility	26	$34.29	$47.57	$48.91
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $29.35 / $41.61 / $58.40	Professional	26	$29.35	$41.61	$58.40
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $44.80 / $53.47 / $106.40	Professional	TC	$44.80	$53.47	$106.40
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.45 / $173.33 / $210.31	Professional		$108.45	$173.33	$210.31
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.08 / $57.30 / $67.95	Professional	26	$34.08	$57.30	$67.95
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $73.41 / $115.12 / $143.25	Professional	TC	$73.41	$115.12	$143.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $97.36 / $142.86 / $181.47	Professional		$97.36	$142.86	$181.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.72 / $46.62 / $60.36	Professional	26	$33.72	$46.62	$60.36
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $62.97 / $96.94 / $120.98	Professional	TC	$62.97	$96.94	$120.98
United Facility/Professional Professional Modifier Low / Median / High Price $41.79 / $69.65 / $108.42	Professional		$41.79	$69.65	$108.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.68 / $22.40 / $53.76	Professional	26	$15.68	$22.40	$53.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.98 / $31.51 / $67.40	Professional	TC	$25.98	$31.51	$67.40