Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.38 / $125.96 / $173.47	Professional		$84.38	$125.96	$173.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.01 / $34.07 / $205.70	Professional	26	$26.01	$34.07	$205.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.37 / $91.90 / $124.53	Professional	TC	$58.37	$91.90	$124.53
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $91.00 / $256.47 / $256.47	Facility	26	$91.00	$256.47	$256.47
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $149.38 / $280.45 / $1,210.67	Professional		$149.38	$280.45	$1,210.67
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.81 / $82.51 / $360.79	Professional	26	$44.81	$82.51	$360.79
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $105.87 / $200.86 / $914.18	Professional	TC	$105.87	$200.86	$914.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.10 / $120.54 / $210.00	Professional		$55.10	$120.54	$210.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.18 / $36.11 / $65.54	Professional	26	$18.18	$36.11	$65.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.92 / $87.61 / $141.86	Professional	TC	$36.92	$87.61	$141.86
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $42.86 / $84.31 / $146.15	Facility	26	$42.86	$84.31	$146.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $155.81 / $280.52 / $499.70	Professional		$155.81	$280.52	$499.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.42 / $84.03 / $119.24	Professional	26	$51.42	$84.03	$119.24
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $104.38 / $205.13 / $368.37	Professional	TC	$104.38	$205.13	$368.37
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.43 / $104.68 / $297.07	Professional		$19.43	$104.68	$297.07
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $52.79 / $63.87 / $87.71	Facility	26	$52.79	$63.87	$87.71
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.88 / $76.31 / $113.23	Professional	26	$44.88	$76.31	$113.23
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $95.92 / $176.00 / $343.07	Professional	TC	$95.92	$176.00	$343.07
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $157.09 / $260.58 / $314.00	Professional		$157.09	$260.58	$314.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.95 / $76.14 / $89.08	Professional	26	$44.95	$76.14	$89.08
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $111.59 / $184.45 / $224.01	Professional	TC	$111.59	$184.45	$224.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $153.38 / $213.57 / $281.37	Professional		$153.38	$213.57	$281.37
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.81 / $62.44 / $80.51	Professional	26	$44.81	$62.44	$80.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $108.57 / $152.46 / $200.86	Professional	TC	$108.57	$152.46	$200.86
United Facility/Professional Professional Modifier Low / Median / High Price $69.08 / $69.08 / $234.89	Professional		$69.08	$69.08	$234.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.44 / $31.05 / $70.06	Professional	26	$21.44	$31.05	$70.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.64 / $67.48 / $174.80	Professional	TC	$47.64	$67.48	$174.80