Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.90 / $126.44 / $206.56	Facility	26	$63.90	$126.44	$206.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $289.36 / $475.00 / $751.97	Professional		$289.36	$475.00	$751.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.90 / $105.47 / $180.22	Professional	26	$63.90	$105.47	$180.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.40 / $335.00 / $571.82	Professional	TC	$218.40	$335.00	$571.82
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $530.79 / $530.79 / $530.79	Facility	26	$530.79	$530.79	$530.79
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $328.94 / $591.79 / $2,955.62	Professional		$328.94	$591.79	$2,955.62
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.08 / $135.28 / $596.05	Professional	26	$78.08	$135.28	$596.05
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $259.52 / $478.74 / $2,626.86	Professional	TC	$259.52	$478.74	$2,626.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $256.33 / $568.63 / $924.03	Professional		$256.33	$568.63	$924.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.37 / $103.20 / $178.54	Professional	26	$56.37	$103.20	$178.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $197.91 / $448.03 / $767.52	Professional	TC	$197.91	$448.03	$767.52
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $62.96 / $127.74 / $1,102.78	Facility	26	$62.96	$127.74	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $381.64 / $667.32 / $1,303.79	Professional		$381.64	$667.32	$1,303.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.80 / $120.41 / $155.19	Professional	26	$55.80	$120.41	$155.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $321.25 / $558.23 / $1,167.15	Professional	TC	$321.25	$558.23	$1,167.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $43.01 / $251.57 / $541.02	Professional		$43.01	$251.57	$541.02
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $92.34 / $110.96 / $114.57	Facility	26	$92.34	$110.96	$114.57
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $268.35 / $268.35	Professional		$268.35	$268.35	$268.35
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $67.54 / $102.08 / $119.07	Professional	26	$67.54	$102.08	$119.07
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $326.61 / $563.45 / $828.82	Professional	TC	$326.61	$563.45	$828.82
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $76.56 / $76.56 / $76.78	Facility	26	$76.56	$76.56	$76.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $366.01 / $559.27 / $687.96	Professional		$366.01	$559.27	$687.96
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $86.82 / $131.86 / $157.47	Professional	26	$86.82	$131.86	$157.47
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $278.89 / $419.68 / $526.21	Professional	TC	$278.89	$419.68	$526.21
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $851.78	Facility	26	$714.15	$714.15	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $328.94 / $485.09 / $727.22	Professional		$328.94	$485.09	$727.22
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $78.08 / $116.26 / $157.27	Professional	26	$78.08	$116.26	$157.27
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $250.87 / $368.84 / $569.24	Professional	TC	$250.87	$368.84	$569.24
United Facility/Professional Professional Modifier Low / Median / High Price $221.18 / $443.71 / $768.50	Professional		$221.18	$443.71	$768.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.15 / $64.42 / $165.59	Professional	26	$52.15	$64.42	$165.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.03 / $382.77 / $621.35	Professional	TC	$169.03	$382.77	$621.35
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $265.66 / $265.66 / $265.66	Professional		$265.66	$265.66	$265.66
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $58.83 / $58.83 / $58.83	Professional	26	$58.83	$58.83	$58.83
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $206.82 / $206.82 / $206.82	Professional	TC	$206.82	$206.82	$206.82