Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $76.39 / $129.99 / $169.27	Facility	26	$76.39	$129.99	$169.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.85 / $191.59 / $317.23	Professional		$124.85	$191.59	$317.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.09 / $76.39 / $160.52	Professional	26	$59.09	$76.39	$160.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.12 / $119.93 / $182.08	Professional	TC	$63.12	$119.93	$182.08
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $139.00 / $211.40 / $352.88	Facility	26	$139.00	$211.40	$352.88
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $161.24 / $301.51 / $1,060.27	Professional		$161.24	$301.51	$1,060.27
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $80.43 / $146.04 / $486.90	Professional	26	$80.43	$146.04	$486.90
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.68 / $155.91 / $707.89	Professional	TC	$85.68	$155.91	$707.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $150.04 / $240.85 / $401.49	Professional		$150.04	$240.85	$401.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.09 / $110.94 / $187.38	Professional	26	$65.09	$110.94	$187.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.95 / $123.61 / $213.65	Professional	TC	$76.95	$123.61	$213.65
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $58.19 / $124.88 / $208.92	Facility	26	$58.19	$124.88	$208.92
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $150.66 / $267.14 / $404.14	Professional		$150.66	$267.14	$404.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.19 / $122.76 / $156.97	Professional	26	$58.19	$122.76	$156.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $87.64 / $141.58 / $257.63	Professional	TC	$87.64	$141.58	$257.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.43 / $100.68 / $227.98	Professional		$21.43	$100.68	$227.98
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $91.14 / $116.52 / $119.00	Facility	26	$91.14	$116.52	$119.00
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $77.98 / $105.53 / $131.15	Professional	26	$77.98	$105.53	$131.15
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $76.20 / $114.72 / $202.62	Professional	TC	$76.20	$114.72	$202.62
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $78.37 / $78.37 / $80.43	Facility	26	$78.37	$78.37	$80.43
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $178.36 / $271.67 / $329.32	Professional		$178.36	$271.67	$329.32
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $89.82 / $134.16 / $164.96	Professional	26	$89.82	$134.16	$164.96
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $88.79 / $135.44 / $164.03	Professional	TC	$88.79	$135.44	$164.03
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 $158.47 / $229.09 / $310.81	Professional		$158.47	$229.09	$310.81
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.93 / $115.21 / $155.85	Professional	26	$79.93	$115.21	$155.85
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $78.54 / $113.88 / $155.91	Professional	TC	$78.54	$113.88	$155.91
United Facility/Professional Professional Modifier Low / Median / High Price $145.32 / $234.00 / $347.56	Professional		$145.32	$234.00	$347.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.25 / $105.01 / $175.04	Professional	26	$68.25	$105.01	$175.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.81 / $119.95 / $171.76	Professional	TC	$71.81	$119.95	$171.76
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $130.37 / $130.37 / $130.37	Professional		$130.37	$130.37	$130.37
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $61.82 / $61.82 / $61.82	Professional	26	$61.82	$61.82	$61.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $68.55 / $68.55 / $68.55	Professional	TC	$68.55	$68.55	$68.55