Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.32 / $25.98 / $86.00	Facility	26	$13.32	$25.98	$86.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.89 / $111.76 / $371.00	Professional		$90.89	$111.76	$371.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $14.23 / $71.81	Professional	26	$11.77	$14.23	$71.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.11 / $98.44 / $285.00	Professional	TC	$79.11	$98.44	$285.00
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $110.80 / $110.80 / $110.80	Facility	26	$110.80	$110.80	$110.80
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $133.32 / $248.13 / $876.62	Professional		$133.32	$248.13	$876.62
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.17 / $27.43 / $270.04	Professional	26	$16.17	$27.43	$270.04
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $115.29 / $212.85 / $820.61	Professional	TC	$115.29	$212.85	$820.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.76 / $215.19 / $364.33	Professional		$109.76	$215.19	$364.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.63 / $21.36 / $37.26	Professional	26	$11.63	$21.36	$37.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $98.97 / $191.51 / $325.68	Professional	TC	$98.97	$191.51	$325.68
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $14.35 / $26.53 / $236.39	Facility	26	$14.35	$26.53	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.07 / $250.80 / $400.01	Professional		$123.07	$250.80	$400.01
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $25.77 / $32.58	Professional	26	$12.88	$25.77	$32.58
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $112.22 / $224.99 / $364.75	Professional	TC	$112.22	$224.99	$364.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.26 / $162.65 / $275.14	Professional		$27.26	$162.65	$275.14
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.64 / $23.13 / $23.45	Facility	26	$17.64	$23.13	$23.45
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.96 / $21.00 / $24.67	Professional	26	$15.96	$21.00	$24.67
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $134.38 / $185.51 / $253.11	Professional	TC	$134.38	$185.51	$253.11
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $15.86 / $15.86 / $16.00	Facility	26	$15.86	$15.86	$16.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $162.38 / $243.78 / $295.12	Professional		$162.38	$243.78	$295.12
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.32 / $27.09 / $32.81	Professional	26	$17.32	$27.09	$32.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $144.34 / $216.54 / $263.02	Professional	TC	$144.34	$216.54	$263.02
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 $148.30 / $214.52 / $299.82	Professional		$148.30	$214.52	$299.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.17 / $24.22 / $32.19	Professional	26	$16.17	$24.22	$32.19
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $132.13 / $191.13 / $267.63	Professional	TC	$132.13	$191.13	$267.63
United Facility/Professional Professional Modifier Low / Median / High Price $98.78 / $151.40 / $299.24	Professional		$98.78	$151.40	$299.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.74 / $13.20 / $34.47	Professional	26	$10.74	$13.20	$34.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.04 / $146.91 / $276.39	Professional	TC	$88.04	$146.91	$276.39
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $116.72 / $116.72 / $116.72	Professional		$116.72	$116.72	$116.72
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $12.26 / $12.26 / $12.26	Professional	26	$12.26	$12.26	$12.26
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $104.46 / $104.46 / $104.46	Professional	TC	$104.46	$104.46	$104.46