Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.86 / $74.34 / $119.92	Facility	26	$55.86	$74.34	$119.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.00 / $161.69 / $284.89	Professional		$120.00	$161.69	$284.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.99 / $54.11 / $104.52	Professional	26	$39.99	$54.11	$104.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.09 / $109.81 / $205.39	Professional	TC	$70.09	$109.81	$205.39
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $214.20 / $214.20	Facility	26	$100.00	$214.20	$214.20
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $170.48 / $321.66 / $1,401.23	Professional		$170.48	$321.66	$1,401.23
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.55 / $95.82 / $343.28	Professional	26	$55.55	$95.82	$343.28
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $135.59 / $187.50 / $294.76	Professional	50	$135.59	$187.50	$294.76
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $112.26 / $220.09 / $1,057.95	Professional	TC	$112.26	$220.09	$1,057.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.73 / $234.66 / $500.61	Professional		$112.73	$234.66	$500.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.33 / $77.23 / $127.04	Professional	26	$43.33	$77.23	$127.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.04 / $145.78 / $375.09	Professional	TC	$58.04	$145.78	$375.09
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $42.78 / $91.94 / $762.02	Facility	26	$42.78	$91.94	$762.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $103.85 / $198.95 / $358.43	Professional		$103.85	$198.95	$358.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.78 / $89.11 / $116.84	Professional	26	$42.78	$89.11	$116.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.35 / $106.54 / $250.39	Professional	TC	$51.35	$106.54	$250.39
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.51 / $155.56 / $376.05	Professional		$30.51	$155.56	$376.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $68.20 / $82.41 / $83.08	Facility	26	$68.20	$82.41	$83.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $54.27 / $70.05 / $89.79	Professional	26	$54.27	$70.05	$89.79
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $55.81 / $91.12 / $164.58	Professional	TC	$55.81	$91.12	$164.58
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $55.27 / $55.27 / $56.67	Facility	26	$55.27	$55.27	$56.67
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $221.92 / $310.70 / $456.47	Professional		$221.92	$310.70	$456.47
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.71 / $95.76 / $116.51	Professional	26	$62.71	$95.76	$116.51
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $157.80 / $224.49 / $329.28	Professional	TC	$157.80	$224.49	$329.28
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $513.03 / $513.03 / $838.61	Facility	26	$513.03	$513.03	$838.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $170.48 / $255.79 / $387.53	Professional		$170.48	$255.79	$387.53
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.36 / $81.44 / $109.80	Professional	26	$56.36	$81.44	$109.80
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $114.11 / $178.24 / $275.70	Professional	TC	$114.11	$178.24	$275.70
United Facility/Professional Professional Modifier Low / Median / High Price $111.34 / $191.17 / $394.89	Professional		$111.34	$191.17	$394.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.55 / $73.79 / $120.17	Professional	26	$46.55	$73.79	$120.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.98 / $119.95 / $270.75	Professional	TC	$64.98	$119.95	$270.75
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $181.73 / $181.73 / $181.73	Professional		$181.73	$181.73	$181.73
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.92 / $44.92 / $44.92	Professional	26	$44.92	$44.92	$44.92
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $136.82 / $136.82 / $136.82	Professional	TC	$136.82	$136.82	$136.82