Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.92 / $140.50 / $514.12	Professional		$58.92	$140.50	$514.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.85 / $21.81 / $57.27	Professional	26	$16.85	$21.81	$57.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.07 / $89.55 / $187.20	Professional	TC	$42.07	$89.55	$187.20
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $118.17 / $224.10 / $766.65	Professional		$118.17	$224.10	$766.65
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $48.45 / $171.71	Professional	26	$28.18	$48.45	$171.71
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $82.65 / $174.51 / $605.03	Professional	TC	$82.65	$174.51	$605.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.95 / $91.83 / $132.27	Professional		$39.95	$91.83	$132.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $23.15 / $34.58	Professional	26	$11.48	$23.15	$34.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.30 / $71.50 / $99.41	Professional	TC	$28.30	$71.50	$99.41
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $28.01 / $43.41 / $58.11	Facility	26	$28.01	$43.41	$58.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $103.55 / $162.60 / $243.90	Professional		$103.55	$162.60	$243.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.01 / $44.71 / $58.11	Professional	26	$28.01	$44.71	$58.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.54 / $117.88 / $191.77	Professional	TC	$75.54	$117.88	$191.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.73 / $105.24 / $187.42	Professional		$17.73	$105.24	$187.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $31.89 / $38.51 / $43.55	Facility	26	$31.89	$38.51	$43.55
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $25.73 / $32.00 / $52.24	Professional	26	$25.73	$32.00	$52.24
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $77.00 / $98.70 / $192.93	Professional	TC	$77.00	$98.70	$192.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.50 / $209.45 / $253.81	Professional		$120.50	$209.45	$253.81
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.80 / $46.46 / $55.10	Professional	26	$27.80	$46.46	$55.10
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $93.77 / $162.99 / $199.73	Professional	TC	$93.77	$162.99	$199.73
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $119.13 / $170.10 / $224.10	Professional		$119.13	$170.10	$224.10
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $38.38 / $49.80	Professional	26	$28.18	$38.38	$49.80
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $82.65 / $134.65 / $174.30	Professional	TC	$82.65	$134.65	$174.30
United Facility/Professional Professional Modifier Low / Median / High Price $58.21 / $59.11 / $153.36	Professional		$58.21	$59.11	$153.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.86 / $18.76 / $35.96	Professional	26	$13.86	$18.76	$35.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.70 / $64.37 / $174.59	Professional	TC	$42.70	$64.37	$174.59