Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.92 / $60.51 / $99.24	Facility	26	$31.92	$60.51	$99.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.73 / $141.44 / $281.05	Professional		$90.73	$141.44	$281.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.26 / $31.92 / $76.67	Professional	26	$24.26	$31.92	$76.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.45 / $109.09 / $212.03	Professional	TC	$66.45	$109.09	$212.03
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $125.66 / $125.66	Facility	26	$100.00	$125.66	$125.66
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $159.56 / $324.18 / $1,120.28	Professional		$159.56	$324.18	$1,120.28
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.81 / $67.23 / $237.00	Professional	26	$38.81	$67.23	$237.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $130.44 / $244.19 / $883.28	Professional	TC	$130.44	$244.19	$883.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.71 / $207.27 / $420.94	Professional		$110.71	$207.27	$420.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.82 / $50.02 / $84.92	Professional	26	$28.82	$50.02	$84.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.31 / $159.32 / $331.99	Professional	TC	$84.31	$159.32	$331.99
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $27.28 / $60.76 / $1,002.46	Facility	26	$27.28	$60.76	$1,002.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.31 / $207.03 / $344.05	Professional		$102.31	$207.03	$344.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.28 / $58.44 / $77.17	Professional	26	$27.28	$58.44	$77.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $74.66 / $148.33 / $272.68	Professional	TC	$74.66	$148.33	$272.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.31 / $148.77 / $312.97	Professional		$29.31	$148.77	$312.97
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $45.60 / $54.42 / $56.28	Facility	26	$45.60	$54.42	$56.28
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.77 / $47.74 / $58.10	Professional	26	$33.77	$47.74	$58.10
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $92.12 / $123.61 / $179.80	Professional	TC	$92.12	$123.61	$179.80
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $38.04 / $38.04 / $38.39	Facility	26	$38.04	$38.04	$38.39
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $195.71 / $299.70 / $368.42	Professional		$195.71	$299.70	$368.42
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.79 / $65.02 / $79.00	Professional	26	$42.79	$65.02	$79.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $151.28 / $235.88 / $288.45	Professional	TC	$151.28	$235.88	$288.45
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 $187.11 / $265.10 / $363.16	Professional		$187.11	$265.10	$363.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $40.32 / $57.79 / $77.51	Professional	26	$40.32	$57.79	$77.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $148.30 / $207.55 / $287.04	Professional	TC	$148.30	$207.55	$287.04
United Facility/Professional Professional Modifier Low / Median / High Price $107.67 / $146.50 / $342.92	Professional		$107.67	$146.50	$342.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.57 / $35.06 / $87.49	Professional	26	$28.57	$35.06	$87.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.45 / $115.56 / $268.52	Professional	TC	$80.45	$115.56	$268.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $143.91 / $143.91 / $143.91	Professional		$143.91	$143.91	$143.91
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $29.19 / $29.19 / $29.19	Professional	26	$29.19	$29.19	$29.19
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $114.72 / $114.72 / $114.72	Professional	TC	$114.72	$114.72	$114.72