Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $73.98 / $115.55	Professional		$50.00	$73.98	$115.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.04 / $43.38 / $58.87	Professional	26	$31.04	$43.38	$58.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.06 / $30.13 / $48.27	Professional	TC	$21.06	$30.13	$48.27
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $48.47 / $84.68 / $165.02	Facility	26	$48.47	$84.68	$165.02
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $85.01 / $156.69 / $541.04	Professional		$85.01	$156.69	$541.04
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.92 / $84.64 / $347.34	Professional	26	$43.92	$84.64	$347.34
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.22 / $66.68 / $239.93	Professional	TC	$35.22	$66.68	$239.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.82 / $99.81 / $194.75	Professional		$57.82	$99.81	$194.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.14 / $59.80 / $110.20	Professional	26	$34.14	$59.80	$110.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.48 / $41.04 / $84.55	Professional	TC	$22.48	$41.04	$84.55
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $36.01 / $52.54 / $95.97	Facility	26	$36.01	$52.54	$95.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $60.20 / $92.50 / $162.88	Professional		$60.20	$92.50	$162.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.96 / $54.50 / $93.46	Professional	26	$35.96	$54.50	$93.46
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.78 / $38.69 / $70.31	Professional	TC	$23.78	$38.69	$70.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.73 / $62.91 / $149.31	Professional		$10.73	$62.91	$149.31
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.90 / $71.69 / $73.03	Facility	26	$53.90	$71.69	$73.03
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $52.92 / $52.92 / $52.92	Professional		$52.92	$52.92	$52.92
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.62 / $62.64 / $76.68	Professional	26	$44.62	$62.64	$76.68
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.06 / $38.76 / $54.75	Professional	TC	$28.06	$38.76	$54.75
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $48.47 / $48.47 / $48.47	Facility	26	$48.47	$48.47	$48.47
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.67 / $148.43 / $173.26	Professional		$97.67	$148.43	$173.26
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.11 / $85.27 / $98.87	Professional	26	$56.11	$85.27	$98.87
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.56 / $63.33 / $74.38	Professional	TC	$41.56	$63.33	$74.38
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $85.01 / $124.24 / $157.54	Professional		$85.01	$124.24	$157.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.43 / $70.90 / $89.90	Professional	26	$49.43	$70.90	$89.90
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $35.57 / $52.91 / $67.63	Professional	TC	$35.57	$52.91	$67.63
United Facility/Professional Professional Modifier Low / Median / High Price $46.34 / $91.29 / $176.20	Professional		$46.34	$91.29	$176.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.45 / $55.65 / $104.28	Professional	26	$26.45	$55.65	$104.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.89 / $38.03 / $72.94	Professional	TC	$19.89	$38.03	$72.94