Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.68 / $44.58 / $61.25	Facility	26	$28.68	$44.58	$61.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.09 / $63.76 / $150.00	Professional		$36.09	$63.76	$150.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.96 / $33.25 / $52.45	Professional	26	$19.96	$33.25	$52.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.13 / $26.09 / $97.42	Professional	TC	$16.13	$26.09	$97.42
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $201.45 / $201.45	Facility	26	$100.00	$201.45	$201.45
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $53.13 / $91.83 / $764.92	Professional		$53.13	$91.83	$764.92
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.11 / $52.29 / $382.94	Professional	26	$29.11	$52.29	$382.94
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $39.29 / $47.97 / $209.21	Professional	50	$39.29	$47.97	$209.21
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.02 / $41.95 / $585.86	Professional	TC	$24.02	$41.95	$585.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.70 / $82.11 / $154.87	Professional		$42.70	$82.11	$154.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $41.90 / $70.77	Professional	26	$23.44	$41.90	$70.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.30 / $37.79 / $104.27	Professional	TC	$19.30	$37.79	$104.27
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $23.63 / $48.21 / $315.92	Facility	26	$23.63	$48.21	$315.92
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $37.54 / $84.18 / $235.85	Professional		$37.54	$84.18	$235.85
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.96 / $47.28 / $73.55	Professional	26	$20.96	$47.28	$73.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $16.57 / $35.20 / $162.29	Professional	TC	$16.57	$35.20	$162.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.20 / $54.50 / $92.81	Professional		$9.20	$54.50	$92.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $34.64 / $41.76 / $50.09	Facility	26	$34.64	$41.76	$50.09
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.73 / $41.27 / $59.74	Professional	26	$28.73	$41.27	$59.74
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $20.90 / $30.82 / $130.41	Professional	TC	$20.90	$30.82	$130.41
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $28.54 / $28.54 / $28.79	Facility	26	$28.54	$28.54	$28.79
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.80 / $90.56 / $111.38	Professional		$59.80	$90.56	$111.38
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.47 / $49.45 / $59.98	Professional	26	$32.47	$49.45	$59.98
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.31 / $41.75 / $51.41	Professional	TC	$27.31	$41.75	$51.41
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $217.18 / $217.18 / $354.01	Facility	26	$217.18	$217.18	$354.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $53.13 / $76.09 / $100.50	Professional		$53.13	$76.09	$100.50
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $29.11 / $41.42 / $56.59	Professional	26	$29.11	$41.42	$56.59
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $24.02 / $35.04 / $46.39	Professional	TC	$24.02	$35.04	$46.39
United Facility/Professional Professional Modifier Low / Median / High Price $42.90 / $80.84 / $156.68	Professional		$42.90	$80.84	$156.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.94 / $44.20 / $62.38	Professional	26	$23.94	$44.20	$62.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.00 / $37.39 / $106.59	Professional	TC	$18.00	$37.39	$106.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $43.25 / $43.25 / $43.25	Professional		$43.25	$43.25	$43.25
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $22.45 / $22.45 / $22.45	Professional	26	$22.45	$22.45	$22.45
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $20.80 / $20.80 / $20.80	Professional	TC	$20.80	$20.80	$20.80