Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.59 / $129.78 / $164.17	Facility	26	$74.59	$129.78	$164.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $155.75 / $226.83 / $440.90	Professional		$155.75	$226.83	$440.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $74.59 / $145.11	Professional	26	$53.70	$74.59	$145.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.06 / $152.22 / $293.08	Professional	TC	$102.06	$152.22	$293.08
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $106.44 / $261.89 / $261.89	Facility	26	$106.44	$261.89	$261.89
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $435.67 / $800.69 / $1,731.57	Professional		$435.67	$800.69	$1,731.57
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.93 / $143.59 / $484.88	Professional	26	$79.93	$143.59	$484.88
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $221.39 / $619.57 / $1,410.54	Professional	TC	$221.39	$619.57	$1,410.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $345.34 / $602.97 / $1,078.73	Professional		$345.34	$602.97	$1,078.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.25 / $104.84 / $185.29	Professional	26	$63.25	$104.84	$185.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $284.20 / $492.50 / $904.40	Professional	TC	$284.20	$492.50	$904.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $55.80 / $119.27 / $202.18	Facility	26	$55.80	$119.27	$202.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $314.04 / $611.61 / $852.32	Professional		$314.04	$611.61	$852.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.80 / $117.52 / $150.56	Professional	26	$55.80	$117.52	$150.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $259.16 / $493.35 / $703.37	Professional	TC	$259.16	$493.35	$703.37
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.07 / $155.06 / $356.32	Professional		$29.07	$155.06	$356.32
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $95.09 / $114.22 / $116.58	Facility	26	$95.09	$114.22	$116.58
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $69.55 / $98.53 / $118.57	Professional	26	$69.55	$98.53	$118.57
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $313.56 / $444.40 / $562.40	Professional	TC	$313.56	$444.40	$562.40
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $78.37 / $78.37 / $79.52	Facility	26	$78.37	$78.37	$79.52
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $484.48 / $736.24 / $920.43	Professional		$484.48	$736.24	$920.43
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $88.87 / $132.63 / $163.09	Professional	26	$88.87	$132.63	$163.09
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $401.20 / $602.79 / $757.34	Professional	TC	$401.20	$602.79	$757.34
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 $435.67 / $631.64 / $850.41	Professional		$435.67	$631.64	$850.41
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.93 / $113.49 / $154.08	Professional	26	$79.93	$113.49	$154.08
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $355.74 / $518.41 / $699.73	Professional	TC	$355.74	$518.41	$699.73
United Facility/Professional Professional Modifier Low / Median / High Price $358.81 / $528.60 / $906.29	Professional		$358.81	$528.60	$906.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.20 / $96.85 / $175.49	Professional	26	$67.20	$96.85	$175.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $284.00 / $429.55 / $741.95	Professional	TC	$284.00	$429.55	$741.95
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $190.69 / $190.69 / $190.69	Professional		$190.69	$190.69	$190.69
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $61.09 / $61.09 / $61.09	Professional	26	$61.09	$61.09	$61.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $129.59 / $129.59 / $129.59	Professional	TC	$129.59	$129.59	$129.59