Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.23 / $183.73 / $244.93	Facility	26	$107.23	$183.73	$244.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $271.75 / $421.10 / $715.11	Professional		$271.75	$421.10	$715.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.81 / $107.23 / $219.28	Professional	26	$78.81	$107.23	$219.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $202.00 / $310.98 / $495.83	Professional	TC	$202.00	$310.98	$495.83
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $110.99 / $165.55 / $516.30	Facility	26	$110.99	$165.55	$516.30
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $423.83 / $750.32 / $2,600.48	Professional		$423.83	$750.32	$2,600.48
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $118.07 / $206.67 / $697.13	Professional	26	$118.07	$206.67	$697.13
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $307.69 / $543.65 / $1,903.35	Professional	TC	$307.69	$543.65	$1,903.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $340.69 / $641.62 / $976.46	Professional		$340.69	$641.62	$976.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.27 / $172.57 / $250.28	Professional	26	$109.27	$172.57	$250.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $231.42 / $469.05 / $715.51	Professional	TC	$231.42	$469.05	$715.51
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $103.97 / $187.03 / $807.38	Facility	26	$103.97	$187.03	$807.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $245.83 / $532.41 / $799.69	Professional		$245.83	$532.41	$799.69
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $103.97 / $177.62 / $215.72	Professional	26	$103.97	$177.62	$215.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $219.83 / $375.55 / $595.72	Professional	TC	$219.83	$375.55	$595.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $49.27 / $269.62 / $608.50	Professional		$49.27	$269.62	$608.50
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $127.89 / $163.08 / $166.60	Facility	26	$127.89	$163.08	$166.60
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.93 / $160.93 / $527.90	Professional		$160.93	$160.93	$527.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $98.40 / $139.08 / $184.50	Professional	26	$98.40	$139.08	$184.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $233.16 / $308.37 / $437.51	Professional	TC	$233.16	$308.37	$437.51
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $110.99 / $110.99 / $113.34	Facility	26	$110.99	$110.99	$113.34
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $423.83 / $687.85 / $844.51	Professional		$423.83	$687.85	$844.51
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $118.07 / $189.46 / $232.45	Professional	26	$118.07	$189.46	$232.45
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $307.17 / $498.39 / $612.05	Professional	TC	$307.17	$498.39	$612.05
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $516.30 / $516.30 / $1,906.19	Facility	26	$516.30	$516.30	$1,906.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $420.88 / $592.32 / $797.84	Professional		$420.88	$592.32	$797.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $113.19 / $163.04 / $219.60	Professional	26	$113.19	$163.04	$219.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $307.69 / $429.29 / $578.23	Professional	TC	$307.69	$429.29	$578.23
United Facility/Professional Professional Modifier Low / Median / High Price $356.65 / $652.96 / $872.81	Professional		$356.65	$652.96	$872.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $106.92 / $170.11 / $240.41	Professional	26	$106.92	$170.11	$240.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $255.20 / $461.51 / $632.40	Professional	TC	$255.20	$461.51	$632.40