Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.38 / $142.97 / $244.09	Professional		$107.38	$142.97	$244.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.81 / $17.38 / $23.10	Professional	26	$13.81	$17.38	$23.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $92.26 / $126.73 / $203.43	Professional	TC	$92.26	$126.73	$203.43
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $19.93 / $34.29 / $100.00	Facility	26	$19.93	$34.29	$100.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $127.65 / $300.02 / $1,154.93	Professional		$127.65	$300.02	$1,154.93
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.18 / $27.86 / $135.38	Professional	26	$15.18	$27.86	$135.38
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.22 / $250.67 / $1,032.98	Professional	TC	$109.22	$250.67	$1,032.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.26 / $176.68 / $408.42	Professional		$95.26	$176.68	$408.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.63 / $23.96 / $44.27	Professional	26	$14.63	$23.96	$44.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.95 / $154.75 / $365.55	Professional	TC	$79.95	$154.75	$365.55
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $14.26 / $20.59 / $37.86	Facility	26	$14.26	$20.59	$37.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.08 / $157.44 / $300.39	Professional		$97.08	$157.44	$300.39
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.76 / $21.25 / $37.72	Professional	26	$13.76	$21.25	$37.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.20 / $134.75 / $260.04	Professional	TC	$81.20	$134.75	$260.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.69 / $204.06 / $373.40	Professional		$34.69	$204.06	$373.40
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $21.07 / $28.81 / $29.48	Facility	26	$21.07	$28.81	$29.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.92 / $24.51 / $29.48	Professional	26	$15.92	$24.51	$29.48
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $95.48 / $140.10 / $222.49	Professional	TC	$95.48	$140.10	$222.49
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $19.93 / $19.93 / $19.93	Facility	26	$19.93	$19.93	$19.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $198.80 / $300.02 / $361.03	Professional		$198.80	$300.02	$361.03
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.86 / $34.65 / $40.07	Professional	26	$22.86	$34.65	$40.07
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $176.34 / $265.19 / $321.11	Professional	TC	$176.34	$265.19	$321.11
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $127.65 / $133.41 / $252.60	Professional		$127.65	$133.41	$252.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.42 / $15.18 / $29.33	Professional	26	$14.42	$15.18	$29.33
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $112.47 / $117.92 / $223.28	Professional	TC	$112.47	$117.92	$223.28
United Facility/Professional Professional Modifier Low / Median / High Price $113.22 / $166.41 / $345.53	Professional		$113.22	$166.41	$345.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.23 / $22.41 / $43.20	Professional	26	$14.23	$22.41	$43.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $94.64 / $143.69 / $293.52	Professional	TC	$94.64	$143.69	$293.52