Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.00 / $72.26 / $124.29	Facility	26	$36.00	$72.26	$124.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $71.04 / $93.64 / $202.52	Professional		$71.04	$93.64	$202.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $36.00 / $85.08	Professional	26	$29.75	$36.00	$85.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.62 / $57.65 / $126.80	Professional	TC	$43.62	$57.65	$126.80
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $74.77 / $145.31 / $145.31	Facility	26	$74.77	$145.31	$145.31
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $103.49 / $195.07 / $642.29	Professional		$103.49	$195.07	$642.29
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.43 / $76.06 / $335.18	Professional	26	$43.43	$76.06	$335.18
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $118.60 / $144.10 / $248.74	Professional	50	$118.60	$144.10	$248.74
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.15 / $115.12 / $379.65	Professional	TC	$61.15	$115.12	$379.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.51 / $153.31 / $244.12	Professional		$96.51	$153.31	$244.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.79 / $60.42 / $98.28	Professional	26	$36.79	$60.42	$98.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.34 / $90.77 / $151.29	Professional	TC	$58.34	$90.77	$151.29
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $33.79 / $71.70 / $122.43	Facility	26	$33.79	$71.70	$122.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $91.45 / $180.23 / $243.75	Professional		$91.45	$180.23	$243.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.79 / $70.48 / $89.81	Professional	26	$33.79	$70.48	$89.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $58.90 / $110.29 / $153.66	Professional	TC	$58.90	$110.29	$153.66
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.75 / $69.40 / $221.04	Professional		$12.75	$69.40	$221.04
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $49.49 / $63.65 / $68.34	Facility	26	$49.49	$63.65	$68.34
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $40.79 / $58.00 / $73.73	Professional	26	$40.79	$58.00	$73.73
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $67.34 / $91.12 / $122.20	Professional	TC	$67.34	$91.12	$122.20
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $42.58 / $42.58 / $43.42	Facility	26	$42.58	$42.58	$43.42
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $115.63 / $173.12 / $210.89	Professional		$115.63	$173.12	$210.89
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.97 / $72.42 / $89.04	Professional	26	$48.97	$72.42	$89.04
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.50 / $100.62 / $121.85	Professional	TC	$66.50	$100.62	$121.85
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $103.49 / $148.97 / $202.09	Professional		$103.49	$148.97	$202.09
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.43 / $62.90 / $85.33	Professional	26	$43.43	$62.90	$85.33
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $60.06 / $87.49 / $118.57	Professional	TC	$60.06	$87.49	$118.57
United Facility/Professional Professional Modifier Low / Median / High Price $83.50 / $101.41 / $240.03	Professional		$83.50	$101.41	$240.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.47 / $36.81 / $88.92	Professional	26	$33.47	$36.81	$88.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.41 / $65.86 / $152.90	Professional	TC	$49.41	$65.86	$152.90
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $84.33 / $84.33 / $84.33	Professional		$84.33	$84.33	$84.33
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $34.33 / $34.33 / $34.33	Professional	26	$34.33	$34.33	$34.33
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $50.00 / $50.00 / $50.00	Professional	TC	$50.00	$50.00	$50.00