Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $149.15 / $337.45 / $518.67	Facility	26	$149.15	$337.45	$518.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $317.47 / $458.83 / $915.34	Professional		$317.47	$458.83	$915.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.81 / $149.15 / $337.45	Professional	26	$131.81	$149.15	$337.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $185.65 / $309.68 / $582.10	Professional	TC	$185.65	$309.68	$582.10
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $201.13 / $697.88 / $697.88	Facility	26	$201.13	$697.88	$697.88
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $615.85 / $1,066.57 / $3,963.90	Professional		$615.85	$1,066.57	$3,963.90
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $206.56 / $356.04 / $1,257.30	Professional	26	$206.56	$356.04	$1,257.30
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $410.72 / $716.72 / $2,706.60	Professional	TC	$410.72	$716.72	$2,706.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $459.00 / $885.48 / $1,490.14	Professional		$459.00	$885.48	$1,490.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $186.28 / $305.79 / $482.52	Professional	26	$186.28	$305.79	$482.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $268.23 / $594.75 / $1,013.10	Professional	TC	$268.23	$594.75	$1,013.10
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $140.43 / $338.29 / $1,073.72	Facility	26	$140.43	$338.29	$1,073.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $434.30 / $787.49 / $1,204.46	Professional		$434.30	$787.49	$1,204.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $142.05 / $327.54 / $406.20	Professional	26	$142.05	$327.54	$406.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $255.06 / $461.28 / $830.76	Professional	TC	$255.06	$461.28	$830.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $85.13 / $424.90 / $984.57	Professional		$85.13	$424.90	$984.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $207.27 / $291.45 / $302.83	Facility	26	$207.27	$291.45	$302.83
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $248.67 / $248.67 / $248.67	Professional		$248.67	$248.67	$248.67
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $181.70 / $248.60 / $302.83	Professional	26	$181.70	$248.60	$302.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $297.82 / $509.30 / $620.41	Professional	TC	$297.82	$509.30	$620.41
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $201.13 / $201.13 / $206.56	Facility	26	$201.13	$201.13	$206.56
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $696.85 / $1,050.45 / $1,249.98	Professional		$696.85	$1,050.45	$1,249.98
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $232.19 / $344.56 / $411.84	Professional	26	$232.19	$344.56	$411.84
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $467.98 / $696.68 / $839.97	Professional	TC	$467.98	$696.68	$839.97
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $657.04 / $657.04 / $1,088.88	Facility	26	$657.04	$657.04	$1,088.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $615.85 / $919.43 / $1,237.72	Professional		$615.85	$919.43	$1,237.72
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $205.13 / $309.62 / $405.99	Professional	26	$205.13	$309.62	$405.99
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $410.72 / $608.75 / $831.73	Professional	TC	$410.72	$608.75	$831.73
United Facility/Professional Professional Modifier Low / Median / High Price $444.98 / $521.95 / $1,180.63	Professional		$444.98	$521.95	$1,180.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $187.61 / $196.24 / $391.53	Professional	26	$187.61	$196.24	$391.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $258.69 / $351.77 / $757.31	Professional	TC	$258.69	$351.77	$757.31
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $530.22 / $530.22 / $530.22	Professional		$530.22	$530.22	$530.22
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $163.78 / $163.78 / $163.78	Professional	26	$163.78	$163.78	$163.78
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $366.45 / $366.45 / $366.45	Professional	TC	$366.45	$366.45	$366.45