Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.21 / $67.94 / $110.06	Facility	26	$34.21	$67.94	$110.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $65.00 / $79.95 / $185.94	Professional		$65.00	$79.95	$185.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.28 / $33.97 / $80.42	Professional	26	$26.28	$33.97	$80.42
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $28.66 / $39.97 / $117.07	Professional	52	$28.66	$39.97	$117.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.06 / $49.53 / $111.60	Professional	TC	$36.06	$49.53	$111.60
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $69.53 / $136.22 / $136.22	Facility	26	$69.53	$136.22	$136.22
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $93.67 / $172.66 / $582.67	Professional		$93.67	$172.66	$582.67
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.65 / $70.11 / $320.31	Professional	26	$40.65	$70.11	$320.31
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $68.68 / $123.33 / $165.15	Professional	50	$68.68	$123.33	$165.15
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $53.67 / $97.29 / $336.00	Professional	TC	$53.67	$97.29	$336.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.51 / $131.02 / $219.22	Professional		$82.51	$131.02	$219.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.33 / $54.33 / $91.11	Professional	26	$32.33	$54.33	$91.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.88 / $75.17 / $128.30	Professional	TC	$49.88	$75.17	$128.30
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $29.45 / $62.07 / $106.70	Facility	26	$29.45	$62.07	$106.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $78.04 / $149.99 / $199.94	Professional		$78.04	$149.99	$199.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.45 / $60.76 / $78.61	Professional	26	$29.45	$60.76	$78.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.45 / $89.17 / $125.53	Professional	TC	$46.45	$89.17	$125.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.62 / $65.14 / $147.48	Professional		$12.62	$65.14	$147.48
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.61 / $58.96 / $59.84	Facility	26	$43.61	$58.96	$59.84
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $40.94 / $51.87 / $62.75	Professional	26	$40.94	$51.87	$62.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $59.50 / $77.02 / $102.00	Professional	TC	$59.50	$77.02	$102.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $39.86 / $39.86 / $40.67	Facility	26	$39.86	$39.86	$40.67
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $103.62 / $153.84 / $191.21	Professional		$103.62	$153.84	$191.21
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.88 / $67.84 / $83.42	Professional	26	$45.88	$67.84	$83.42
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $57.74 / $85.22 / $107.79	Professional	TC	$57.74	$85.22	$107.79
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 $91.48 / $134.11 / $180.64	Professional		$91.48	$134.11	$180.64
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $40.65 / $58.93 / $79.94	Professional	26	$40.65	$58.93	$79.94
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $50.82 / $75.59 / $103.29	Professional	TC	$50.82	$75.59	$103.29
United Facility/Professional Professional Modifier Low / Median / High Price $67.84 / $82.01 / $190.94	Professional		$67.84	$82.01	$190.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.87 / $33.18 / $82.87	Professional	26	$29.87	$33.18	$82.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.09 / $49.85 / $102.10	Professional	TC	$36.09	$49.85	$102.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $77.17 / $77.17 / $77.17	Professional		$77.17	$77.17	$77.17
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $32.31 / $32.31 / $32.31	Professional	26	$32.31	$32.31	$32.31
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $44.87 / $44.87 / $44.87	Professional	TC	$44.87	$44.87	$44.87