Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $92.62 / $183.44 / $299.81	Facility	26	$92.62	$183.44	$299.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $366.15 / $475.00 / $965.14	Professional		$366.15	$475.00	$965.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.04 / $124.36 / $239.00	Professional	26	$84.04	$124.36	$239.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.35 / $335.00 / $704.40	Professional	TC	$259.35	$335.00	$704.40
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $764.32 / $764.32	Facility	26	$714.15	$764.32	$764.32
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $442.13 / $789.32 / $3,392.38	Professional		$442.13	$789.32	$3,392.38
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $112.73 / $200.81 / $671.85	Professional	26	$112.73	$200.81	$671.85
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $329.41 / $625.09 / $2,981.99	Professional	TC	$329.41	$625.09	$2,981.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $337.42 / $675.43 / $1,154.48	Professional		$337.42	$675.43	$1,154.48
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 $258.10 / $534.97 / $923.76	Professional	TC	$258.10	$534.97	$923.76
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $90.94 / $185.62 / $1,102.78	Facility	26	$90.94	$185.62	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $457.74 / $830.06 / $1,493.92	Professional		$457.74	$830.06	$1,493.92
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 $359.46 / $648.20 / $1,295.55	Professional	TC	$359.46	$648.20	$1,295.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $65.05 / $291.11 / $687.42	Professional		$65.05	$291.11	$687.42
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 Low / Median / High Price $268.35 / $268.35 / $457.29	Professional		$268.35	$268.35	$457.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.99 / $140.22 / $177.84	Professional	26	$102.99	$140.22	$177.84
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $389.64 / $534.16 / $862.62	Professional	TC	$389.64	$534.16	$862.62
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 $489.73 / $734.64 / $937.85	Professional		$489.73	$734.64	$937.85
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $126.03 / $190.31 / $228.38	Professional	26	$126.03	$190.31	$228.38
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $363.43 / $555.33 / $710.01	Professional	TC	$363.43	$555.33	$710.01
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 $442.13 / $645.64 / $985.20	Professional		$442.13	$645.64	$985.20
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 $329.41 / $478.17 / $737.99	Professional	TC	$329.41	$478.17	$737.99
United Facility/Professional Professional Modifier Low / Median / High Price $303.70 / $575.12 / $985.30	Professional		$303.70	$575.12	$985.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.47 / $100.86 / $243.11	Professional	26	$75.47	$100.86	$243.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $228.23 / $397.83 / $743.09	Professional	TC	$228.23	$397.83	$743.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $351.45 / $351.45 / $351.45	Professional		$351.45	$351.45	$351.45
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 $266.41 / $266.41 / $266.41	Professional	TC	$266.41	$266.41	$266.41