Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.00 / $148.94 / $578.21	Professional		$85.00	$148.94	$578.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.12 / $41.91 / $125.73	Professional	26	$30.12	$41.91	$125.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.88 / $107.03 / $414.41	Professional	TC	$54.88	$107.03	$414.41
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $99.68 / $271.50 / $271.50	Facility	26	$99.68	$271.50	$271.50
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $177.16 / $343.66 / $1,273.95	Professional		$177.16	$343.66	$1,273.95
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.98 / $101.56 / $390.67	Professional	26	$54.98	$101.56	$390.67
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.47 / $241.33 / $939.75	Professional	TC	$128.47	$241.33	$939.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.14 / $152.51 / $221.13	Professional		$62.14	$152.51	$221.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.76 / $44.32 / $73.98	Professional	26	$21.76	$44.32	$73.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.47 / $111.32 / $161.25	Professional	TC	$38.47	$111.32	$161.25
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $51.35 / $93.45 / $149.31	Facility	26	$51.35	$93.45	$149.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $175.49 / $328.21 / $466.12	Professional		$175.49	$328.21	$466.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.11 / $93.45 / $122.81	Professional	26	$56.11	$93.45	$122.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $113.36 / $227.76 / $343.49	Professional	TC	$113.36	$227.76	$343.49
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.87 / $146.75 / $379.42	Professional		$27.87	$146.75	$379.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $67.09 / $80.40 / $104.31	Facility	26	$67.09	$80.40	$104.31
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $47.44 / $86.01 / $107.97	Professional	26	$47.44	$86.01	$107.97
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $85.22 / $195.51 / $273.76	Professional	TC	$85.22	$195.51	$273.76
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $201.13 / $321.20 / $389.40	Professional		$201.13	$321.20	$389.40
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.96 / $93.40 / $111.13	Professional	26	$56.96	$93.40	$111.13
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $145.87 / $225.40 / $278.27	Professional	TC	$145.87	$225.40	$278.27
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $177.16 / $265.17 / $346.19	Professional		$177.16	$265.17	$346.19
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $54.98 / $76.23 / $100.43	Professional	26	$54.98	$76.23	$100.43
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $128.47 / $188.57 / $241.37	Professional	TC	$128.47	$188.57	$241.37
United Facility/Professional Professional Modifier Low / Median / High Price $80.33 / $89.14 / $273.16	Professional		$80.33	$89.14	$273.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.99 / $36.82 / $67.42	Professional	26	$25.99	$36.82	$67.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.34 / $90.58 / $145.28	Professional	TC	$54.34	$90.58	$145.28