Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.93 / $348.84 / $613.71	Professional		$151.93	$348.84	$613.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.18 / $131.02 / $181.29	Professional	26	$89.18	$131.02	$181.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.41 / $127.12 / $172.04	Professional	TC	$67.41	$127.12	$172.04
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $328.00 / $579.90 / $579.90	Facility	26	$328.00	$579.90	$579.90
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $319.82 / $576.71 / $1,994.33	Professional		$319.82	$576.71	$1,994.33
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $170.02 / $298.33 / $965.25	Professional	26	$170.02	$298.33	$965.25
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $149.83 / $279.22 / $1,029.08	Professional	TC	$149.83	$279.22	$1,029.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $113.06 / $240.70 / $349.02	Professional		$113.06	$240.70	$349.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.75 / $130.91 / $199.74	Professional	26	$63.75	$130.91	$199.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.35 / $121.04 / $175.51	Professional	TC	$48.35	$121.04	$175.51
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $117.18 / $236.80 / $360.93	Facility	26	$117.18	$236.80	$360.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $266.94 / $520.49 / $675.71	Professional		$266.94	$520.49	$675.71
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $152.78 / $254.06 / $330.13	Professional	26	$152.78	$254.06	$330.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $128.07 / $239.55 / $351.55	Professional	TC	$128.07	$239.55	$351.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.71 / $237.71 / $511.20	Professional		$39.71	$237.71	$511.20
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $189.14 / $235.60 / $250.58	Facility	26	$189.14	$235.60	$250.58
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $139.90 / $225.60 / $281.62	Professional	26	$139.90	$225.60	$281.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $97.69 / $167.11 / $279.89	Professional	TC	$97.69	$167.11	$279.89
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $321.60 / $547.91 / $637.37	Professional		$321.60	$547.91	$637.37
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $166.36 / $279.52 / $330.33	Professional	26	$166.36	$279.52	$330.33
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $159.00 / $263.00 / $307.66	Professional	TC	$159.00	$263.00	$307.66
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $327.75 / $440.37 / $576.02	Professional		$327.75	$440.37	$576.02
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $172.33 / $230.91 / $297.97	Professional	26	$172.33	$230.91	$297.97
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $140.05 / $213.41 / $271.67	Professional	TC	$140.05	$213.41	$271.67
United Facility/Professional Professional Modifier Low / Median / High Price $141.11 / $204.31 / $490.38	Professional		$141.11	$204.31	$490.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $80.34 / $121.66 / $208.42	Professional	26	$80.34	$121.66	$208.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.88 / $68.20 / $217.22	Professional	TC	$63.88	$68.20	$217.22