Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.56 / $64.51 / $197.51	Facility	26	$47.56	$64.51	$197.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $264.19 / $336.23 / $652.67	Professional		$264.19	$336.23	$652.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.10 / $43.62 / $76.09	Professional	26	$36.10	$43.62	$76.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $227.88 / $282.04 / $431.04	Professional	TC	$227.88	$282.04	$431.04
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.74 / $171.05 / $171.05	Facility	26	$50.74	$171.05	$171.05
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $348.81 / $590.22 / $2,162.25	Professional		$348.81	$590.22	$2,162.25
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.74 / $88.85 / $317.63	Professional	26	$51.74	$88.85	$317.63
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $297.07 / $518.55 / $1,844.63	Professional	TC	$297.07	$518.55	$1,844.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.54 / $478.32 / $814.48	Professional		$295.54	$478.32	$814.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.57 / $67.56 / $115.93	Professional	26	$42.57	$67.56	$115.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $254.00 / $409.69 / $707.11	Professional	TC	$254.00	$409.69	$707.11
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $42.51 / $79.02 / $131.24	Facility	26	$42.51	$79.02	$131.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $268.45 / $502.28 / $730.73	Professional		$268.45	$502.28	$730.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.34 / $76.62 / $97.03	Professional	26	$41.34	$76.62	$97.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $246.54 / $456.95 / $633.69	Professional	TC	$246.54	$456.95	$633.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $45.88 / $272.11 / $572.34	Professional		$45.88	$272.11	$572.34
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $61.05 / $72.41 / $74.37	Facility	26	$61.05	$72.41	$74.37
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $240.84 / $240.84 / $240.84	Professional		$240.84	$240.84	$240.84
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.22 / $61.05 / $74.37	Professional	26	$44.22	$61.05	$74.37
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $313.35 / $411.97 / $423.44	Professional	TC	$313.35	$411.97	$423.44
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $50.73 / $50.73 / $50.74	Facility	26	$50.73	$50.73	$50.74
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $383.53 / $566.39 / $696.41	Professional		$383.53	$566.39	$696.41
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.74 / $85.22 / $104.04	Professional	26	$57.74	$85.22	$104.04
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $325.80 / $481.77 / $595.12	Professional	TC	$325.80	$481.77	$595.12
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $785.39	Facility	26	$446.45	$446.45	$785.39
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $348.81 / $488.45 / $657.93	Professional		$348.81	$488.45	$657.93
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $51.74 / $72.97 / $98.29	Professional	26	$51.74	$72.97	$98.29
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $297.07 / $415.47 / $559.64	Professional	TC	$297.07	$415.47	$559.64
United Facility/Professional Professional Modifier Low / Median / High Price $301.19 / $436.74 / $744.14	Professional		$301.19	$436.74	$744.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.00 / $59.99 / $108.13	Professional	26	$44.00	$59.99	$108.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $250.76 / $385.79 / $636.54	Professional	TC	$250.76	$385.79	$636.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $284.64 / $284.64 / $284.64	Professional		$284.64	$284.64	$284.64
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.47 / $38.47 / $38.47	Professional	26	$38.47	$38.47	$38.47
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $246.17 / $246.17 / $246.17	Professional	TC	$246.17	$246.17	$246.17