Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.23 / $141.00 / $231.07	Facility	26	$72.23	$141.00	$231.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $308.87 / $416.13 / $863.95	Professional		$308.87	$416.13	$863.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.15 / $72.23 / $178.54	Professional	26	$57.15	$72.23	$178.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $250.43 / $343.90 / $706.28	Professional	TC	$250.43	$343.90	$706.28
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $86.07 / $133.88 / $2,533.52	Facility	26	$86.07	$133.88	$2,533.52
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $441.71 / $727.56 / $2,079.76	Professional		$441.71	$727.56	$2,079.76
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.78 / $148.88 / $405.29	Professional	26	$87.78	$148.88	$405.29
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $352.80 / $595.50 / $2,189.33	Professional	TC	$352.80	$595.50	$2,189.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $449.05 / $731.57 / $1,095.77	Professional		$449.05	$731.57	$1,095.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.04 / $134.13 / $209.69	Professional	26	$85.04	$134.13	$209.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $364.01 / $598.04 / $887.22	Professional	TC	$364.01	$598.04	$887.22
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $62.31 / $153.87 / $5,739.12	Facility	26	$62.31	$153.87	$5,739.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $348.75 / $769.89 / $1,044.36	Professional		$348.75	$769.89	$1,044.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.31 / $146.16 / $190.31	Professional	26	$62.31	$146.16	$190.31
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $286.44 / $618.29 / $854.06	Professional	TC	$286.44	$618.29	$854.06
Molina Facility/Professional Professional Modifier Low / Median / High Price $49.21 / $334.88 / $686.69	Professional		$49.21	$334.88	$686.69
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $95.06 / $125.23 / $129.19	Facility	26	$95.06	$125.23	$129.19
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $76.38 / $108.30 / $129.97	Professional	26	$76.38	$108.30	$129.97
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $317.18 / $449.73 / $542.70	Professional	TC	$317.18	$449.73	$542.70
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $86.07 / $86.07 / $86.37	Facility	26	$86.07	$86.07	$86.37
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $485.45 / $719.05 / $886.49	Professional		$485.45	$719.05	$886.49
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $97.09 / $144.07 / $177.15	Professional	26	$97.09	$144.07	$177.15
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $388.36 / $577.84 / $714.00	Professional	TC	$388.36	$577.84	$714.00
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,533.52 / $2,533.52 / $4,053.27	Facility	26	$2,533.52	$2,533.52	$4,053.27
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $444.91 / $649.79 / $917.86	Professional		$444.91	$649.79	$917.86
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $105.07 / $130.79 / $177.36	Professional	26	$105.07	$130.79	$177.36
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $416.93 / $529.20 / $742.20	Professional	TC	$416.93	$529.20	$742.20
United Facility/Professional Professional Modifier Low / Median / High Price $295.41 / $364.92 / $897.74	Professional		$295.41	$364.92	$897.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.29 / $72.00 / $172.32	Professional	26	$58.29	$72.00	$172.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $237.12 / $292.92 / $689.23	Professional	TC	$237.12	$292.92	$689.23