Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.33 / $133.76 / $218.86	Facility	26	$67.33	$133.76	$218.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $216.07 / $342.37 / $466.06	Professional		$216.07	$342.37	$466.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.56 / $67.33 / $134.56	Professional	26	$54.56	$67.33	$134.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.59 / $270.52 / $346.70	Professional	TC	$154.59	$270.52	$346.70
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $561.91 / $561.91 / $561.91	Facility	26	$561.91	$561.91	$561.91
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $285.05 / $492.45 / $2,293.84	Professional		$285.05	$492.45	$2,293.84
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.16 / $141.79 / $523.40	Professional	26	$83.16	$141.79	$523.40
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $201.89 / $364.63 / $2,412.00	Professional	TC	$201.89	$364.63	$2,412.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $221.84 / $470.01 / $729.65	Professional		$221.84	$470.01	$729.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.50 / $108.86 / $189.01	Professional	26	$59.50	$108.86	$189.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $160.38 / $347.57 / $574.41	Professional	TC	$160.38	$347.57	$574.41
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $66.64 / $136.21 / $539.79	Facility	26	$66.64	$136.21	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $267.83 / $537.65 / $931.09	Professional		$267.83	$537.65	$931.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.21 / $127.46 / $165.21	Professional	26	$59.21	$127.46	$165.21
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $221.76 / $413.36 / $771.24	Professional	TC	$221.76	$413.36	$771.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.65 / $201.84 / $457.79	Professional		$36.65	$201.84	$457.79
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.83 / $117.40 / $121.27	Facility	26	$97.83	$117.40	$121.27
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $270.14 / $270.14 / $270.14	Professional		$270.14	$270.14	$270.14
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.36 / $102.03 / $127.61	Professional	26	$72.36	$102.03	$127.61
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $230.67 / $333.21 / $462.50	Professional	TC	$230.67	$333.21	$462.50
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $81.34 / $81.34 / $81.54	Facility	26	$81.34	$81.34	$81.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $317.55 / $479.53 / $586.87	Professional		$317.55	$479.53	$586.87
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $92.47 / $138.93 / $166.84	Professional	26	$92.47	$138.93	$166.84
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $224.76 / $339.37 / $421.20	Professional	TC	$224.76	$339.37	$421.20
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $346.39 / $851.78	Facility	26	$346.39	$346.39	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $285.05 / $421.43 / $625.14	Professional		$285.05	$421.43	$625.14
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.16 / $123.18 / $166.47	Professional	26	$83.16	$123.18	$166.47
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $201.89 / $298.25 / $448.75	Professional	TC	$201.89	$298.25	$448.75
United Facility/Professional Professional Modifier Low / Median / High Price $197.86 / $335.40 / $635.33	Professional		$197.86	$335.40	$635.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.91 / $71.09 / $176.90	Professional	26	$54.91	$71.09	$176.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $142.94 / $242.32 / $459.55	Professional	TC	$142.94	$242.32	$459.55
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $228.16 / $228.16 / $228.16	Professional		$228.16	$228.16	$228.16
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $62.26 / $62.26 / $62.26	Professional	26	$62.26	$62.26	$62.26
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $165.90 / $165.90 / $165.90	Professional	TC	$165.90	$165.90	$165.90