Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.35 / $75.92 / $125.96	Facility	26	$50.35	$75.92	$125.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.95 / $95.16 / $186.17	Professional		$66.95	$95.16	$186.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.29 / $50.35 / $103.11	Professional	26	$42.29	$50.35	$103.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.57 / $41.52 / $71.55	Professional	TC	$22.57	$41.52	$71.55
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $72.06 / $83.68 / $176.34	Facility	26	$72.06	$83.68	$176.34
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $98.26 / $165.88 / $611.85	Professional		$98.26	$165.88	$611.85
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.71 / $82.18 / $293.33	Professional	26	$48.71	$82.18	$293.33
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.87 / $82.55 / $318.52	Professional	TC	$42.87	$82.55	$318.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $68.84 / $128.41 / $245.93	Professional		$68.84	$128.41	$245.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.03 / $71.05 / $117.11	Professional	26	$41.03	$71.05	$117.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.61 / $58.83 / $127.86	Professional	TC	$21.61	$58.83	$127.86
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $36.72 / $54.60 / $100.43	Facility	26	$36.72	$54.60	$100.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.20 / $80.75 / $156.87	Professional		$53.20	$80.75	$156.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.72 / $53.30 / $95.14	Professional	26	$34.72	$53.30	$95.14
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $17.07 / $27.32 / $55.44	Professional	TC	$17.07	$27.32	$55.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.95 / $61.90 / $145.42	Professional		$14.95	$61.90	$145.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $58.26 / $71.02 / $87.10	Facility	26	$58.26	$71.02	$87.10
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $52.26 / $75.02 / $93.42	Professional	26	$52.26	$75.02	$93.42
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.54 / $36.45 / $84.15	Professional	TC	$25.54	$36.45	$84.15
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $48.44 / $48.92 / $48.92	Facility	26	$48.44	$48.92	$48.92
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.38 / $163.13 / $195.03	Professional		$106.38	$163.13	$195.03
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.48 / $80.80 / $98.36	Professional	26	$55.48	$80.80	$98.36
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $54.45 / $79.70 / $100.18	Professional	TC	$54.45	$79.70	$100.18
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $72.06 / $72.06 / $127.19	Facility	26	$72.06	$72.06	$127.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $96.25 / $129.52 / $180.94	Professional		$96.25	$129.52	$180.94
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.90 / $67.54 / $89.64	Professional	26	$49.90	$67.54	$89.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $44.74 / $65.54 / $89.90	Professional	TC	$44.74	$65.54	$89.90
United Facility/Professional Professional Modifier Low / Median / High Price $78.54 / $105.21 / $198.74	Professional		$78.54	$105.21	$198.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.36 / $64.14 / $105.34	Professional	26	$45.36	$64.14	$105.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.60 / $42.39 / $96.52	Professional	TC	$27.60	$42.39	$96.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $29.27 / $58.52 / $78.89	Professional		$29.27	$58.52	$78.89
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.18 / $37.18 / $37.18	Professional	26	$37.18	$37.18	$37.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $41.71 / $41.71 / $41.71	Professional	TC	$41.71	$41.71	$41.71