Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.40 / $54.78 / $74.43	Facility	26	$35.40	$54.78	$74.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.95 / $147.62 / $242.04	Professional		$76.95	$147.62	$242.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.70 / $35.40 / $80.75	Professional	26	$15.70	$35.40	$80.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.29 / $98.60 / $181.74	Professional	TC	$49.29	$98.60	$181.74
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $44.39 / $148.36 / $148.36	Facility	26	$44.39	$148.36	$148.36
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $175.00 / $313.35 / $1,149.23	Professional		$175.00	$313.35	$1,149.23
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.39 / $78.37 / $268.88	Professional	26	$44.39	$78.37	$268.88
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $125.07 / $243.81 / $880.35	Professional	TC	$125.07	$243.81	$880.35
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.64 / $13.50 / $23.05	Facility	26	$12.64	$13.50	$23.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.70 / $137.55 / $173.88	Professional		$48.70	$137.55	$173.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.63 / $33.75 / $41.10	Professional	26	$13.63	$33.75	$41.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.08 / $104.47 / $134.77	Professional	TC	$35.08	$104.47	$134.77
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $60.04 / $89.81	Facility	26	$31.62	$60.04	$89.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $130.51 / $248.64 / $377.51	Professional		$130.51	$248.64	$377.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.47 / $66.75 / $91.75	Professional	26	$33.47	$66.75	$91.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $97.03 / $181.55 / $281.20	Professional	TC	$97.03	$181.55	$281.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.68 / $141.88 / $312.97	Professional		$27.68	$141.88	$312.97
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.89 / $65.17 / $68.34	Facility	26	$53.89	$65.17	$68.34
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $43.11 / $53.39 / $68.34	Professional	26	$43.11	$53.39	$68.34
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $135.16 / $162.21 / $211.14	Professional	TC	$135.16	$162.21	$211.14
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $44.39 / $44.39 / $44.85	Facility	26	$44.39	$44.39	$44.85
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.76 / $304.92 / $373.79	Professional		$186.76	$304.92	$373.79
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.76 / $73.43 / $90.92	Professional	26	$45.76	$73.43	$90.92
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $141.00 / $230.21 / $282.87	Professional	TC	$141.00	$230.21	$282.87
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $174.76 / $260.82 / $342.30	Professional		$174.76	$260.82	$342.30
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $45.74 / $64.43 / $82.68	Professional	26	$45.74	$64.43	$82.68
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $125.93 / $198.53 / $259.62	Professional	TC	$125.93	$198.53	$259.62
United Facility/Professional Professional Modifier Low / Median / High Price $61.85 / $84.23 / $182.51	Professional		$61.85	$84.23	$182.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.28 / $21.65 / $46.92	Professional	26	$17.28	$21.65	$46.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.57 / $62.58 / $157.51	Professional	TC	$44.57	$62.58	$157.51