Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.36 / $51.69 / $68.09	Facility	26	$30.36	$51.69	$68.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.27 / $190.40 / $341.92	Professional		$134.27	$190.40	$341.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.76 / $27.08 / $57.29	Professional	26	$18.76	$27.08	$57.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $108.51 / $169.58 / $286.58	Professional	TC	$108.51	$169.58	$286.58
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $53.90 / $174.32 / $174.32	Facility	26	$53.90	$174.32	$174.32
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $174.17 / $313.30 / $1,085.93	Professional		$174.17	$313.30	$1,085.93
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.93 / $54.02 / $303.79	Professional	26	$32.93	$54.02	$303.79
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $145.35 / $265.22 / $922.24	Professional	TC	$145.35	$265.22	$922.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $155.86 / $258.30 / $408.42	Professional		$155.86	$258.30	$408.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.24 / $41.83 / $75.50	Professional	26	$25.24	$41.83	$75.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $126.17 / $213.02 / $343.54	Professional	TC	$126.17	$213.02	$343.54
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $22.01 / $43.97 / $84.24	Facility	26	$22.01	$43.97	$84.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $159.15 / $277.50 / $400.51	Professional		$159.15	$277.50	$400.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.01 / $43.97 / $62.51	Professional	26	$22.01	$43.97	$62.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $128.59 / $231.88 / $352.11	Professional	TC	$128.59	$231.88	$352.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.80 / $143.84 / $310.91	Professional		$28.80	$143.84	$310.91
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.28 / $44.90 / $48.24	Facility	26	$35.28	$44.90	$48.24
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $26.45 / $34.79 / $52.33	Professional	26	$26.45	$34.79	$52.33
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $132.44 / $173.40 / $261.58	Professional	TC	$132.44	$173.40	$261.58
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $31.99 / $31.99 / $32.61	Facility	26	$31.99	$31.99	$32.61
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $191.77 / $285.10 / $350.55	Professional		$191.77	$285.10	$350.55
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.60 / $54.02 / $65.61	Professional	26	$36.60	$54.02	$65.61
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $155.16 / $231.74 / $284.94	Professional	TC	$155.16	$231.74	$284.94
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $174.17 / $245.87 / $331.18	Professional		$174.17	$245.87	$331.18
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.26 / $46.02 / $61.99	Professional	26	$33.26	$46.02	$61.99
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $140.91 / $199.85 / $273.05	Professional	TC	$140.91	$199.85	$273.05
United Facility/Professional Professional Modifier Low / Median / High Price $149.24 / $231.54 / $365.65	Professional		$149.24	$231.54	$365.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.98 / $39.53 / $71.27	Professional	26	$25.98	$39.53	$71.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.03 / $198.49 / $290.61	Professional	TC	$120.03	$198.49	$290.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $141.53 / $141.53 / $141.53	Professional		$141.53	$141.53	$141.53
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $23.77 / $23.77 / $23.77	Professional	26	$23.77	$23.77	$23.77
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $117.76 / $117.76 / $117.76	Professional	TC	$117.76	$117.76	$117.76