Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.75 / $128.86 / $196.54	Professional		$57.75	$128.86	$196.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.30 / $32.65 / $63.35	Professional	26	$18.30	$32.65	$63.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.45 / $96.20 / $137.91	Professional	TC	$39.45	$96.20	$137.91
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $80.39 / $149.85 / $149.85	Facility	26	$80.39	$149.85	$149.85
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $131.63 / $288.48 / $1,105.50	Professional		$131.63	$288.48	$1,105.50
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.97 / $76.89 / $265.95	Professional	26	$42.97	$76.89	$265.95
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $96.73 / $215.80 / $839.63	Professional	TC	$96.73	$215.80	$839.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.29 / $132.36 / $167.18	Professional		$35.29	$132.36	$167.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.36 / $33.93 / $47.46	Professional	26	$12.36	$33.93	$47.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.39 / $96.14 / $128.52	Professional	TC	$23.39	$96.14	$128.52
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $30.69 / $49.86 / $83.17	Facility	26	$30.69	$49.86	$83.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $103.50 / $176.18 / $323.66	Professional		$103.50	$176.18	$323.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.60 / $55.30 / $88.77	Professional	26	$33.60	$55.30	$88.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $69.00 / $123.24 / $244.83	Professional	TC	$69.00	$123.24	$244.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.05 / $140.83 / $316.32	Professional		$28.05	$140.83	$316.32
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.01 / $62.98 / $64.98	Facility	26	$53.01	$62.98	$64.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $42.68 / $53.35 / $64.98	Professional	26	$42.68	$53.35	$64.98
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $105.02 / $158.40 / $192.96	Professional	TC	$105.02	$158.40	$192.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $172.39 / $272.62 / $360.86	Professional		$172.39	$272.62	$360.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.49 / $73.00 / $88.17	Professional	26	$44.49	$73.00	$88.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $126.92 / $197.23 / $246.13	Professional	TC	$126.92	$197.23	$246.13
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $132.35 / $226.28 / $297.99	Professional		$132.35	$226.28	$297.99
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $39.90 / $60.48 / $76.89	Professional	26	$39.90	$60.48	$76.89
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $87.38 / $168.62 / $216.70	Professional	TC	$87.38	$168.62	$216.70
United Facility/Professional Professional Modifier Low / Median / High Price $69.94 / $99.08 / $262.92	Professional		$69.94	$99.08	$262.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.52 / $25.81 / $69.20	Professional	26	$19.52	$25.81	$69.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.59 / $54.49 / $168.62	Professional	TC	$49.59	$54.49	$168.62