Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.00 / $157.72 / $311.47	Facility	26	$96.00	$157.72	$311.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $388.27 / $680.76	Professional		$275.00	$388.27	$680.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.34 / $96.00 / $189.50	Professional	26	$78.34	$96.00	$189.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $212.80 / $309.93 / $560.94	Professional	TC	$212.80	$309.93	$560.94
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $792.40 / $792.40	Facility	26	$346.39	$792.40	$792.40
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $437.77 / $754.77 / $3,081.89	Professional		$437.77	$754.77	$3,081.89
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $116.42 / $210.24 / $697.28	Professional	26	$116.42	$210.24	$697.28
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $325.70 / $574.66 / $2,625.91	Professional	TC	$325.70	$574.66	$2,625.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $320.72 / $617.19 / $1,065.52	Professional		$320.72	$617.19	$1,065.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.18 / $154.46 / $266.42	Professional	26	$84.18	$154.46	$266.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $228.54 / $483.42 / $812.21	Professional	TC	$228.54	$483.42	$812.21
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $104.96 / $191.82 / $539.79	Facility	26	$104.96	$191.82	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $320.70 / $682.50 / $1,183.50	Professional		$320.70	$682.50	$1,183.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $94.25 / $189.44 / $232.38	Professional	26	$94.25	$189.44	$232.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $261.00 / $508.91 / $897.17	Professional	TC	$261.00	$508.91	$897.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $48.08 / $248.09 / $578.88	Professional		$48.08	$248.09	$578.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.05 / $166.54 / $172.86	Facility	26	$138.05	$166.54	$172.86
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $254.17	Professional		$140.29	$140.29	$254.17
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $103.20 / $156.06 / $188.25	Professional	26	$103.20	$156.06	$188.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $284.20 / $445.41 / $705.60	Professional	TC	$284.20	$445.41	$705.60
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $114.16 / $114.16 / $114.71	Facility	26	$114.16	$114.16	$114.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $490.24 / $737.79 / $899.50	Professional		$490.24	$737.79	$899.50
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $130.41 / $194.27 / $236.81	Professional	26	$130.41	$194.27	$236.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $359.82 / $540.16 / $662.69	Professional	TC	$359.82	$540.16	$662.69
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 $442.13 / $648.40 / $888.14	Professional		$442.13	$648.40	$888.14
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $116.42 / $173.69 / $235.44	Professional	26	$116.42	$173.69	$235.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $325.70 / $474.71 / $643.74	Professional	TC	$325.70	$474.71	$643.74
United Facility/Professional Professional Modifier Low / Median / High Price $278.54 / $414.66 / $903.46	Professional		$278.54	$414.66	$903.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.92 / $102.34 / $251.02	Professional	26	$77.92	$102.34	$251.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $200.62 / $334.42 / $703.83	Professional	TC	$200.62	$334.42	$703.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $305.10 / $305.10 / $305.10	Professional		$305.10	$305.10	$305.10
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $88.29 / $88.29 / $88.29	Professional	26	$88.29	$88.29	$88.29
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $216.81 / $216.81 / $216.81	Professional	TC	$216.81	$216.81	$216.81