Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.20 / $46.90 / $73.29	Facility	26	$34.20	$46.90	$73.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.28 / $169.00 / $322.98	Professional		$114.28	$169.00	$322.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $90.39 / $144.12 / $281.33	Professional	TC	$90.39	$144.12	$281.33
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $36.56 / $121.12 / $121.12	Facility	26	$36.56	$121.12	$121.12
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $175.53 / $348.00 / $1,586.03	Professional		$175.53	$348.00	$1,586.03
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $143.07 / $296.55 / $1,364.33	Professional	TC	$143.07	$296.55	$1,364.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.45 / $238.75 / $555.21	Professional		$110.45	$238.75	$555.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $108.86 / $229.24 / $481.27	Professional	TC	$108.86	$229.24	$481.27
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $23.47 / $39.00 / $68.25	Facility	26	$23.47	$39.00	$68.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $109.20 / $191.33 / $390.96	Professional		$109.20	$191.33	$390.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $87.36 / $153.06 / $328.31	Professional	TC	$87.36	$153.06	$328.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.74 / $194.72 / $466.37	Professional		$35.74	$194.72	$466.37
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $39.20 / $52.26 / $53.60	Facility	26	$39.20	$52.26	$53.60
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $125.42 / $179.69 / $287.82	Professional	TC	$125.42	$179.69	$287.82
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $35.33 / $35.33 / $36.56	Facility	26	$35.33	$35.33	$36.56
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $249.98 / $364.58 / $496.18	Professional		$249.98	$364.58	$496.18
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $213.42 / $298.08 / $423.62	Professional	TC	$213.42	$298.08	$423.62
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $459.43 / $459.43 / $513.03	Facility	26	$459.43	$459.43	$513.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $206.51 / $319.32 / $463.21	Professional		$206.51	$319.32	$463.21
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $170.48 / $272.62 / $392.85	Professional	TC	$170.48	$272.62	$392.85
United Facility/Professional Professional Modifier Low / Median / High Price $141.96 / $243.61 / $471.20	Professional		$141.96	$243.61	$471.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.01 / $196.88 / $402.61	Professional	TC	$112.01	$196.88	$402.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $146.04 / $176.92 / $204.95	Professional		$146.04	$176.92	$204.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $123.96 / $150.74 / $176.71	Professional	TC	$123.96	$150.74	$176.71