Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.20 / $188.09 / $308.12	Facility	26	$95.20	$188.09	$308.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $402.08 / $522.50 / $1,065.99	Professional		$402.08	$522.50	$1,065.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.37 / $140.00 / $268.64	Professional	26	$86.37	$140.00	$268.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $284.99 / $368.50 / $797.35	Professional	TC	$284.99	$368.50	$797.35
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $789.92 / $789.92 / $789.92	Facility	26	$789.92	$789.92	$789.92
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $489.26 / $877.31 / $3,014.38	Professional		$489.26	$877.31	$3,014.38
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $115.96 / $207.53 / $693.38	Professional	26	$115.96	$207.53	$693.38
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $373.30 / $674.80 / $2,544.17	Professional	TC	$373.30	$674.80	$2,544.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $375.76 / $733.90 / $1,213.71	Professional		$375.76	$733.90	$1,213.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.82 / $152.96 / $265.61	Professional	26	$83.82	$152.96	$265.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $289.44 / $575.47 / $938.66	Professional	TC	$289.44	$575.47	$938.66
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $97.92 / $178.16 / $232.59	Facility	26	$97.92	$178.16	$232.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $436.79 / $873.01 / $1,419.70	Professional		$436.79	$873.01	$1,419.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $93.15 / $187.22 / $232.38	Professional	26	$93.15	$187.22	$232.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $358.36 / $681.88 / $1,164.78	Professional	TC	$358.36	$681.88	$1,164.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $73.30 / $319.84 / $770.81	Professional		$73.30	$319.84	$770.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $137.50 / $166.53 / $170.85	Facility	26	$137.50	$166.53	$170.85
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.11 / $153.12 / $181.05	Professional	26	$102.11	$153.12	$181.05
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $400.37 / $558.78 / $793.44	Professional	TC	$400.37	$558.78	$793.44
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $113.70 / $113.70 / $114.25	Facility	26	$113.70	$113.70	$114.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $544.88 / $821.26 / $992.94	Professional		$544.88	$821.26	$992.94
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $129.97 / $196.60 / $234.94	Professional	26	$129.97	$196.60	$234.94
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $414.46 / $624.41 / $758.07	Professional	TC	$414.46	$624.41	$758.07
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $489.26 / $721.76 / $1,043.85	Professional		$489.26	$721.76	$1,043.85
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $115.96 / $173.00 / $232.68	Professional	26	$115.96	$173.00	$232.68
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $373.30 / $548.76 / $811.18	Professional	TC	$373.30	$548.76	$811.18
United Facility/Professional Professional Modifier Low / Median / High Price $333.14 / $511.35 / $1,072.33	Professional		$333.14	$511.35	$1,072.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.31 / $95.50 / $248.23	Professional	26	$77.31	$95.50	$248.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $255.83 / $391.27 / $815.67	Professional	TC	$255.83	$391.27	$815.67
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $394.50 / $394.50 / $394.50	Professional		$394.50	$394.50	$394.50
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $88.35 / $88.35 / $88.35	Professional	26	$88.35	$88.35	$88.35
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $306.14 / $306.14 / $306.14	Professional	TC	$306.14	$306.14	$306.14