Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $134.25 / $229.40 / $307.57	Facility	26	$134.25	$229.40	$307.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $241.06 / $515.89 / $887.09	Professional		$241.06	$515.89	$887.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.50 / $134.25 / $279.70	Professional	26	$92.50	$134.25	$279.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $157.22 / $381.64 / $588.80	Professional	TC	$157.22	$381.64	$588.80
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $139.52 / $200.17 / $1,115.05	Facility	26	$139.52	$200.17	$1,115.05
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $508.20 / $870.25 / $3,173.63	Professional		$508.20	$870.25	$3,173.63
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $148.05 / $246.72 / $886.05	Professional	26	$148.05	$246.72	$886.05
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $365.90 / $623.53 / $2,287.58	Professional	TC	$365.90	$623.53	$2,287.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $400.72 / $778.37 / $1,188.08	Professional		$400.72	$778.37	$1,188.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $136.36 / $215.44 / $315.07	Professional	26	$136.36	$215.44	$315.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $264.37 / $562.92 / $860.24	Professional	TC	$264.37	$562.92	$860.24
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $129.86 / $233.61 / $1,701.49	Facility	26	$129.86	$233.61	$1,701.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $341.96 / $631.29 / $898.49	Professional		$341.96	$631.29	$898.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $129.86 / $221.85 / $269.43	Professional	26	$129.86	$221.85	$269.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $252.51 / $416.17 / $669.09	Professional	TC	$252.51	$416.17	$669.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $57.46 / $296.75 / $751.08	Professional		$57.46	$296.75	$751.08
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $171.88 / $203.70 / $209.71	Facility	26	$171.88	$203.70	$209.71
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $138.10 / $199.55 / $230.25	Professional	26	$138.10	$199.55	$230.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $273.36 / $385.92 / $546.88	Professional	TC	$273.36	$385.92	$546.88
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $139.52 / $139.52 / $143.04	Facility	26	$139.52	$139.52	$143.04
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $516.50 / $837.01 / $1,029.16	Professional		$516.50	$837.01	$1,029.16
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $150.18 / $238.60 / $283.92	Professional	26	$150.18	$238.60	$283.92
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $369.26 / $598.41 / $735.78	Professional	TC	$369.26	$598.41	$735.78
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,115.05 / $1,115.05 / $1,906.19	Facility	26	$1,115.05	$1,115.05	$1,906.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $508.20 / $721.83 / $972.28	Professional		$508.20	$721.83	$972.28
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $142.30 / $205.77 / $277.16	Professional	26	$142.30	$205.77	$277.16
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $365.90 / $516.05 / $695.12	Professional	TC	$365.90	$516.05	$695.12
United Facility/Professional Professional Modifier Low / Median / High Price $422.89 / $786.16 / $1,059.15	Professional		$422.89	$786.16	$1,059.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $135.53 / $212.53 / $300.31	Professional	26	$135.53	$212.53	$300.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $275.52 / $541.08 / $758.87	Professional	TC	$275.52	$541.08	$758.87