Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.39 / $80.02 / $130.05	Facility	26	$60.39	$80.02	$130.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.26 / $98.86 / $172.35	Professional		$79.26	$98.86	$172.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.58 / $53.95 / $92.74	Professional	TC	$40.58	$53.95	$92.74
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $62.06 / $202.83 / $202.83	Facility	26	$62.06	$202.83	$202.83
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $112.73 / $201.34 / $808.65	Professional		$112.73	$201.34	$808.65
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.61 / $106.70 / $436.20	Professional	TC	$51.61	$106.70	$436.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.56 / $170.92 / $289.32	Professional		$94.56	$170.92	$289.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.93 / $86.57 / $155.46	Professional	TC	$43.93	$86.57	$155.46
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $40.88 / $68.16 / $121.15	Facility	26	$40.88	$68.16	$121.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $78.84 / $128.04 / $244.77	Professional		$78.84	$128.04	$244.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.20 / $67.76 / $131.57	Professional	TC	$39.20	$67.76	$131.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.34 / $70.15 / $221.99	Professional		$20.34	$70.15	$221.99
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $68.59 / $88.50 / $93.16	Facility	26	$68.59	$88.50	$93.16
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $60.90 / $87.00 / $107.87	Professional	TC	$60.90	$87.00	$107.87
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $61.70 / $61.70 / $62.06	Facility	26	$61.70	$61.70	$62.06
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $136.32 / $216.49 / $266.19	Professional		$136.32	$216.49	$266.19
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $71.76 / $113.58 / $141.85	Professional	TC	$71.76	$113.58	$141.85
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $217.18 / $217.18 / $354.01	Facility	26	$217.18	$217.18	$354.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $139.06 / $186.70 / $254.76	Professional		$139.06	$186.70	$254.76
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $75.77 / $97.95 / $131.94	Professional	TC	$75.77	$97.95	$131.94
United Facility/Professional Professional Modifier Low / Median / High Price $105.50 / $174.59 / $280.26	Professional		$105.50	$174.59	$280.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.35 / $80.52 / $146.28	Professional	TC	$49.35	$80.52	$146.28
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $73.43 / $88.00 / $98.76	Professional		$73.43	$88.00	$98.76
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $36.44 / $44.25 / $51.85	Professional	TC	$36.44	$44.25	$51.85