Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.58 / $98.67 / $155.18	Facility	26	$73.58	$98.67	$155.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $298.66 / $395.96 / $800.74	Professional		$298.66	$395.96	$800.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $249.84 / $335.14 / $682.22	Professional	TC	$249.84	$335.14	$682.22
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $76.31 / $347.00 / $347.00	Facility	26	$76.31	$347.00	$347.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $437.77 / $838.87 / $3,594.60	Professional		$437.77	$838.87	$3,594.60
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $378.55 / $757.73 / $3,129.60	Professional	TC	$378.55	$757.73	$3,129.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $345.69 / $673.33 / $1,276.22	Professional		$345.69	$673.33	$1,276.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $289.92 / $573.80 / $1,108.27	Professional	TC	$289.92	$573.80	$1,108.27
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $47.25 / $80.94 / $143.19	Facility	26	$47.25	$80.94	$143.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $255.13 / $496.48 / $1,013.68	Professional		$255.13	$496.48	$1,013.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $198.10 / $402.59 / $868.87	Professional	TC	$198.10	$402.59	$868.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $73.46 / $368.17 / $997.06	Professional		$73.46	$368.17	$997.06
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $79.94 / $108.54 / $111.89	Facility	26	$79.94	$108.54	$111.89
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $360.51 / $539.67 / $715.85	Professional	TC	$360.51	$539.67	$715.85
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $75.65 / $75.65 / $76.31	Facility	26	$75.65	$75.65	$76.31
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $583.29 / $930.14 / $1,132.00	Professional		$583.29	$930.14	$1,132.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $504.74 / $805.92 / $978.12	Professional	TC	$504.74	$805.92	$978.12
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $513.03 / $513.03 / $838.61	Facility	26	$513.03	$513.03	$838.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $571.03 / $803.40 / $1,067.65	Professional		$571.03	$803.40	$1,067.65
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $493.88 / $694.85 / $921.71	Professional	TC	$493.88	$694.85	$921.71
United Facility/Professional Professional Modifier Low / Median / High Price $365.97 / $669.28 / $1,200.11	Professional		$365.97	$669.28	$1,200.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $289.69 / $579.85 / $1,023.16	Professional	TC	$289.69	$579.85	$1,023.16
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $345.36 / $419.07 / $486.55	Professional		$345.36	$419.07	$486.55
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $299.52 / $364.69 / $427.70	Professional	TC	$299.52	$364.69	$427.70