Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.13 / $66.00 / $101.68	Professional		$38.13	$66.00	$101.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.50 / $23.99 / $32.99	Professional	26	$17.50	$23.99	$32.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.54 / $38.32 / $71.09	Professional	TC	$20.54	$38.32	$71.09
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $27.18 / $47.60 / $100.00	Facility	26	$27.18	$47.60	$100.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $62.83 / $115.86 / $402.83	Professional		$62.83	$115.86	$402.83
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.33 / $50.84 / $168.68	Professional	26	$27.33	$50.84	$168.68
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.11 / $64.81 / $234.08	Professional	TC	$35.11	$64.81	$234.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.34 / $79.78 / $145.76	Professional		$47.34	$79.78	$145.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.77 / $34.54 / $61.52	Professional	26	$20.77	$34.54	$61.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.72 / $44.81 / $83.48	Professional	TC	$25.72	$44.81	$83.48
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $20.74 / $31.20 / $54.59	Facility	26	$20.74	$31.20	$54.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $47.68 / $74.56 / $136.29	Professional		$47.68	$74.56	$136.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.46 / $31.57 / $53.83	Professional	26	$20.46	$31.57	$53.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $26.60 / $43.68 / $77.11	Professional	TC	$26.60	$43.68	$77.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $8.97 / $51.08 / $93.58	Professional		$8.97	$51.08	$93.58
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $31.85 / $40.44 / $42.25	Facility	26	$31.85	$40.44	$42.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $26.53 / $37.61 / $45.26	Professional	26	$26.53	$37.61	$45.26
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $34.20 / $49.09 / $68.40	Professional	TC	$34.20	$49.09	$68.40
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $27.18 / $27.18 / $27.18	Facility	26	$27.18	$27.18	$27.18
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.20 / $109.74 / $127.90	Professional		$72.20	$109.74	$127.90
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.69 / $48.03 / $55.55	Professional	26	$31.69	$48.03	$55.55
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.52 / $61.74 / $72.56	Professional	TC	$40.52	$61.74	$72.56
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $62.83 / $91.72 / $116.30	Professional		$62.83	$91.72	$116.30
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $27.72 / $39.68 / $50.63	Professional	26	$27.72	$39.68	$50.63
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $35.11 / $51.64 / $65.98	Professional	TC	$35.11	$51.64	$65.98
United Facility/Professional Professional Modifier Low / Median / High Price $33.97 / $76.95 / $134.19	Professional		$33.97	$76.95	$134.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.80 / $32.32 / $58.90	Professional	26	$14.80	$32.32	$58.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.17 / $42.19 / $73.34	Professional	TC	$19.17	$42.19	$73.34