Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.10 / $99.95 / $169.02	Facility	26	$51.10	$99.95	$169.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.97 / $168.69 / $371.00	Professional		$145.97	$168.69	$371.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.14 / $51.30 / $111.43	Professional	26	$42.14	$51.30	$111.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $92.45 / $117.54 / $285.00	Professional	TC	$92.45	$117.54	$285.00
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $422.56 / $422.56 / $422.56	Facility	26	$422.56	$422.56	$422.56
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $175.89 / $331.85 / $1,142.40	Professional		$175.89	$331.85	$1,142.40
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $62.37 / $111.94 / $372.68	Professional	26	$62.37	$111.94	$372.68
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $127.05 / $227.14 / $780.77	Professional	TC	$127.05	$227.14	$780.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.87 / $273.17 / $446.02	Professional		$141.87	$273.17	$446.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.42 / $83.09 / $142.02	Professional	26	$45.42	$83.09	$142.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.89 / $186.63 / $317.38	Professional	TC	$95.89	$186.63	$317.38
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $45.26 / $102.33 / $236.39	Facility	26	$45.26	$102.33	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.07 / $316.83 / $485.04	Professional		$154.07	$316.83	$485.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.26 / $97.88 / $123.48	Professional	26	$45.26	$97.88	$123.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $111.29 / $212.24 / $361.72	Professional	TC	$111.29	$212.24	$361.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.15 / $149.27 / $312.59	Professional		$29.15	$149.27	$312.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $88.29 / $93.80	Facility	26	$73.64	$88.29	$93.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $56.28 / $78.66 / $95.90	Professional	26	$56.28	$78.66	$95.90
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $124.03 / $180.90 / $276.70	Professional	TC	$124.03	$180.90	$276.70
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $61.16 / $61.16 / $61.24	Facility	26	$61.16	$61.16	$61.24
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $210.32 / $316.13 / $382.70	Professional		$210.32	$316.13	$382.70
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.59 / $103.72 / $126.36	Professional	26	$69.59	$103.72	$126.36
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $140.72 / $211.02 / $259.83	Professional	TC	$140.72	$211.02	$259.83
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $156.94 / $156.94 / $209.36	Facility	26	$156.94	$156.94	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $189.42 / $278.18 / $381.03	Professional		$189.42	$278.18	$381.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $62.37 / $92.73 / $127.84	Professional	26	$62.37	$92.73	$127.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $127.05 / $185.46 / $251.49	Professional	TC	$127.05	$185.46	$251.49
United Facility/Professional Professional Modifier Low / Median / High Price $124.85 / $174.13 / $389.24	Professional		$124.85	$174.13	$389.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.03 / $53.53 / $131.02	Professional	26	$42.03	$53.53	$131.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.82 / $132.29 / $280.62	Professional	TC	$82.82	$132.29	$280.62
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $150.74 / $150.74 / $150.74	Professional		$150.74	$150.74	$150.74
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $46.68 / $46.68 / $46.68	Professional	26	$46.68	$46.68	$46.68
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $104.06 / $104.06 / $104.06	Professional	TC	$104.06	$104.06	$104.06