Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.98 / $60.52 / $92.68	Professional		$42.98	$60.52	$92.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.02 / $9.50 / $13.55	Professional	26	$7.02	$9.50	$13.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.96 / $51.02 / $79.12	Professional	TC	$35.96	$51.02	$79.12
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $11.78 / $11.78 / $59.20	Facility	26	$11.78	$11.78	$59.20
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $72.73 / $138.68 / $472.65	Professional		$72.73	$138.68	$472.65
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.43 / $20.94 / $166.76	Professional	26	$11.43	$20.94	$166.76
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.45 / $117.78 / $402.98	Professional	TC	$61.45	$117.78	$402.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.88 / $84.90 / $166.92	Professional		$46.88	$84.90	$166.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.71 / $14.66 / $24.92	Professional	26	$7.71	$14.66	$24.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.44 / $69.73 / $141.94	Professional	TC	$36.44	$69.73	$141.94
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $10.26 / $13.19 / $25.10	Facility	26	$10.26	$13.19	$25.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $54.56 / $83.28 / $145.63	Professional		$54.56	$83.28	$145.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.44 / $13.38 / $22.89	Professional	26	$10.44	$13.38	$22.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $44.64 / $69.48 / $123.55	Professional	TC	$44.64	$69.48	$123.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $8.88 / $52.86 / $93.58	Professional		$8.88	$52.86	$93.58
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.08 / $16.75 / $18.09	Facility	26	$13.08	$16.75	$18.09
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.96 / $16.35 / $19.50	Professional	26	$11.96	$16.35	$19.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $52.89 / $83.84 / $97.50	Professional	TC	$52.89	$83.84	$97.50
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $11.78 / $11.78 / $11.78	Facility	26	$11.78	$11.78	$11.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.53 / $124.25 / $152.78	Professional		$75.53	$124.25	$152.78
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.35 / $19.78 / $23.68	Professional	26	$12.35	$19.78	$23.68
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.18 / $104.39 / $129.35	Professional	TC	$63.18	$104.39	$129.35
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $73.45 / $106.13 / $134.44	Professional		$73.45	$106.13	$134.44
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.01 / $16.44 / $21.58	Professional	26	$12.01	$16.44	$21.58
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $61.45 / $89.38 / $113.82	Professional	TC	$61.45	$89.38	$113.82
United Facility/Professional Professional Modifier Low / Median / High Price $56.62 / $78.97 / $147.50	Professional		$56.62	$78.97	$147.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.90 / $13.52 / $24.95	Professional	26	$8.90	$13.52	$24.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.19 / $66.41 / $123.09	Professional	TC	$46.19	$66.41	$123.09