Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.35 / $79.09 / $104.37	Professional		$47.35	$79.09	$104.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.47 / $26.23 / $164.90	Professional	26	$15.47	$26.23	$164.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.88 / $52.87 / $67.47	Professional	TC	$31.88	$52.87	$67.47
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $58.62 / $110.49 / $110.49	Facility	26	$58.62	$110.49	$110.49
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $91.67 / $164.95 / $577.50	Professional		$91.67	$164.95	$577.50
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.63 / $60.59 / $197.85	Professional	26	$33.63	$60.59	$197.85
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $55.75 / $106.67 / $379.65	Professional	TC	$55.75	$106.67	$379.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.96 / $76.61 / $100.86	Professional		$28.96	$76.61	$100.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.39 / $26.23 / $35.72	Professional	26	$10.39	$26.23	$35.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.91 / $48.46 / $65.14	Professional	TC	$18.91	$48.46	$65.14
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $26.35 / $42.44 / $70.44	Facility	26	$26.35	$42.44	$70.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.12 / $133.51 / $205.22	Professional		$81.12	$133.51	$205.22
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.32 / $46.61 / $70.44	Professional	26	$28.32	$46.61	$70.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $52.80 / $86.90 / $135.71	Professional	TC	$52.80	$86.90	$135.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.79 / $64.69 / $148.40	Professional		$10.79	$64.69	$148.40
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $40.15 / $48.77 / $51.59	Facility	26	$40.15	$48.77	$51.59
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.60 / $48.91 / $61.50	Professional	26	$33.60	$48.91	$61.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $67.06 / $87.10 / $110.70	Professional	TC	$67.06	$87.10	$110.70
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $94.53 / $159.84 / $187.35	Professional		$94.53	$159.84	$187.35
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.83 / $57.48 / $67.04	Professional	26	$33.83	$57.48	$67.04
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.70 / $102.36 / $120.31	Professional	TC	$60.70	$102.36	$120.31
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $93.79 / $128.52 / $169.32	Professional		$93.79	$128.52	$169.32
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.63 / $45.99 / $60.59	Professional	26	$33.63	$45.99	$60.59
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $59.60 / $82.53 / $108.73	Professional	TC	$59.60	$82.53	$108.73
United Facility/Professional Professional Modifier Low / Median / High Price $41.48 / $45.11 / $116.86	Professional		$41.48	$45.11	$116.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.85 / $21.76 / $43.26	Professional	26	$14.85	$21.76	$43.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.63 / $32.22 / $94.62	Professional	TC	$26.63	$32.22	$94.62