Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.05 / $183.44 / $299.81	Facility	26	$93.05	$183.44	$299.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $329.82 / $475.00 / $859.27	Professional		$329.82	$475.00	$859.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.93 / $124.32 / $239.00	Professional	26	$83.93	$124.32	$239.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $229.10 / $335.00 / $598.54	Professional	TC	$229.10	$335.00	$598.54
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $764.32 / $764.32 / $764.32	Facility	26	$764.32	$764.32	$764.32
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $392.70 / $675.28 / $3,389.77	Professional		$392.70	$675.28	$3,389.77
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $112.73 / $201.64 / $671.85	Professional	26	$112.73	$201.64	$671.85
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $279.97 / $503.37 / $2,953.83	Professional	TC	$279.97	$503.37	$2,953.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $303.29 / $620.21 / $1,048.85	Professional		$303.29	$620.21	$1,048.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.43 / $149.08 / $257.08	Professional	26	$81.43	$149.08	$257.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $218.41 / $469.27 / $805.00	Professional	TC	$218.41	$469.27	$805.00
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $90.94 / $186.33 / $1,102.78	Facility	26	$90.94	$186.33	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $414.97 / $735.73 / $1,377.04	Professional		$414.97	$735.73	$1,377.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $80.59 / $173.93 / $225.21	Professional	26	$80.59	$173.93	$225.21
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $316.60 / $565.91 / $1,178.67	Professional	TC	$316.60	$565.91	$1,178.67
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 $133.10 / $160.31 / $166.16	Facility	26	$133.10	$160.31	$166.16
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $99.70 / $140.79 / $174.84	Professional	26	$99.70	$140.79	$174.84
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $315.66 / $472.68 / $727.65	Professional	TC	$315.66	$472.68	$727.65
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $110.53 / $110.53 / $110.59	Facility	26	$110.53	$110.53	$110.59
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $434.05 / $651.97 / $831.17	Professional		$434.05	$651.97	$831.17
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $126.54 / $190.31 / $229.32	Professional	26	$126.54	$190.31	$229.32
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $307.24 / $461.42 / $589.04	Professional	TC	$307.24	$461.42	$589.04
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 $392.70 / $572.98 / $858.13	Professional		$392.70	$572.98	$858.13
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $112.73 / $167.46 / $227.17	Professional	26	$112.73	$167.46	$227.17
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $279.97 / $405.51 / $625.85	Professional	TC	$279.97	$405.51	$625.85
United Facility/Professional Professional Modifier Low / Median / High Price $268.11 / $454.48 / $863.73	Professional		$268.11	$454.48	$863.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.47 / $98.29 / $239.62	Professional	26	$75.47	$98.29	$239.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $192.64 / $396.62 / $684.52	Professional	TC	$192.64	$396.62	$684.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $311.20 / $311.20 / $311.20	Professional		$311.20	$311.20	$311.20
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $85.04 / $85.04 / $85.04	Professional	26	$85.04	$85.04	$85.04
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $226.16 / $226.16 / $226.16	Professional	TC	$226.16	$226.16	$226.16