Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.96 / $46.35 / $59.92	Facility	26	$28.96	$46.35	$59.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.85 / $57.64 / $93.24	Professional		$29.85	$57.64	$93.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.55 / $27.30 / $54.34	Professional	26	$19.55	$27.30	$54.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.31 / $24.93 / $59.46	Professional	TC	$10.31	$24.93	$59.46
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $41.40 / $80.00 / $92.34	Facility	26	$41.40	$80.00	$92.34
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $65.34 / $122.50 / $455.70	Professional		$65.34	$122.50	$455.70
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.00 / $47.14 / $169.20	Professional	26	$27.00	$47.14	$169.20
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.25 / $73.95 / $286.50	Professional	TC	$38.25	$73.95	$286.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.29 / $86.94 / $183.06	Professional		$40.29	$86.94	$183.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.05 / $38.42 / $67.29	Professional	26	$23.05	$38.42	$67.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.83 / $52.96 / $114.71	Professional	TC	$14.83	$52.96	$114.71
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $18.77 / $28.14 / $51.30	Facility	26	$18.77	$28.14	$51.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $28.48 / $44.64 / $89.04	Professional		$28.48	$44.64	$89.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $18.77 / $27.90 / $50.04	Professional	26	$18.77	$27.90	$50.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $9.69 / $15.66 / $44.64	Professional	TC	$9.69	$15.66	$44.64
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.70 / $50.31 / $91.61	Professional		$9.70	$50.31	$91.61
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.53 / $40.24 / $41.54	Facility	26	$33.53	$40.24	$41.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $27.45 / $35.99 / $41.54	Professional	26	$27.45	$35.99	$41.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $12.76 / $17.55 / $62.53	Professional	TC	$12.76	$17.55	$62.53
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $27.88 / $28.09 / $28.09	Facility	26	$27.88	$28.09	$28.09
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.42 / $120.09 / $144.22	Professional		$79.42	$120.09	$144.22
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.85 / $46.39 / $56.46	Professional	26	$31.85	$46.39	$56.46
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $48.95 / $71.43 / $88.90	Professional	TC	$48.95	$71.43	$88.90
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 $65.48 / $95.70 / $133.63	Professional		$65.48	$95.70	$133.63
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.64 / $38.11 / $51.46	Professional	26	$28.64	$38.11	$51.46
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $40.26 / $59.39 / $80.83	Professional	TC	$40.26	$59.39	$80.83
United Facility/Professional Professional Modifier Low / Median / High Price $41.40 / $69.34 / $141.07	Professional		$41.40	$69.34	$141.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.28 / $32.86 / $60.46	Professional	26	$25.28	$32.86	$60.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $13.33 / $41.75 / $90.26	Professional	TC	$13.33	$41.75	$90.26
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $43.07 / $58.74 / $58.74	Professional		$43.07	$58.74	$58.74
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $16.84 / $21.37 / $21.37	Professional	26	$16.84	$21.37	$21.37
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $26.23 / $37.36 / $37.36	Professional	TC	$26.23	$37.36	$37.36