Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.73 / $187.99 / $309.22	Facility	26	$95.73	$187.99	$309.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $331.55 / $475.00 / $861.95	Professional		$331.55	$475.00	$861.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.09 / $129.09 / $268.36	Professional	26	$86.09	$129.09	$268.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $232.54 / $335.00 / $593.59	Professional	TC	$232.54	$335.00	$593.59
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $792.16 / $792.16 / $792.16	Facility	26	$792.16	$792.16	$792.16
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $393.62 / $671.13 / $3,447.72	Professional		$393.62	$671.13	$3,447.72
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $115.96 / $207.40 / $698.03	Professional	26	$115.96	$207.40	$698.03
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $277.66 / $497.70 / $2,996.90	Professional	TC	$277.66	$497.70	$2,996.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $299.45 / $601.16 / $1,051.41	Professional		$299.45	$601.16	$1,051.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.07 / $153.87 / $266.52	Professional	26	$84.07	$153.87	$266.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $214.01 / $424.62 / $806.68	Professional	TC	$214.01	$424.62	$806.68
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $93.89 / $191.77 / $1,102.78	Facility	26	$93.89	$191.77	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $390.44 / $704.07 / $1,400.09	Professional		$390.44	$704.07	$1,400.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.39 / $179.57 / $233.24	Professional	26	$83.39	$179.57	$233.24
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $282.22 / $522.21 / $1,183.93	Professional	TC	$282.22	$522.21	$1,183.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $56.10 / $268.38 / $603.77	Professional		$56.10	$268.38	$603.77
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.05 / $166.51 / $171.52	Facility	26	$138.05	$166.51	$171.52
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $298.17 / $298.17 / $345.93	Professional		$298.17	$298.17	$345.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $101.30 / $152.54 / $191.25	Professional	26	$101.30	$152.54	$191.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $268.02 / $417.28 / $831.72	Professional	TC	$268.02	$417.28	$831.72
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $113.70 / $113.70 / $114.71	Facility	26	$113.70	$113.70	$114.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $436.11 / $657.48 / $830.23	Professional		$436.11	$657.48	$830.23
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $129.97 / $197.39 / $238.95	Professional	26	$129.97	$197.39	$238.95
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $305.69 / $459.84 / $587.04	Professional	TC	$305.69	$459.84	$587.04
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $1,538.06	Facility	26	$714.15	$714.15	$1,538.06
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $393.62 / $577.82 / $839.69	Professional		$393.62	$577.82	$839.69
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $115.96 / $173.69 / $234.52	Professional	26	$115.96	$173.69	$234.52
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $277.66 / $404.13 / $605.16	Professional	TC	$277.66	$404.13	$605.16
United Facility/Professional Professional Modifier Low / Median / High Price $268.11 / $428.26 / $863.73	Professional		$268.11	$428.26	$863.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $95.88 / $246.45	Professional	26	$77.62	$95.88	$246.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.49 / $380.98 / $665.54	Professional	TC	$190.49	$380.98	$665.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $313.04 / $313.04 / $313.04	Professional		$313.04	$313.04	$313.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $88.46 / $88.46 / $88.46	Professional	26	$88.46	$88.46	$88.46
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $224.58 / $224.58 / $224.58	Professional	TC	$224.58	$224.58	$224.58