Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.09 / $102.99 / $170.87	Facility	26	$72.09	$102.99	$170.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $366.97 / $498.44 / $801.50	Professional		$366.97	$498.44	$801.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.19 / $66.12 / $107.18	Professional	26	$53.19	$66.12	$107.18
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $179.24 / $244.85 / $374.25	Professional	52	$179.24	$244.85	$374.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $308.37 / $430.20 / $694.30	Professional	TC	$308.37	$430.20	$694.30
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $79.52 / $495.00 / $495.00	Facility	26	$79.52	$495.00	$495.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $392.35 / $752.64 / $3,567.83	Professional		$392.35	$752.64	$3,567.83
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.38 / $106.47 / $873.43	Professional	26	$60.38	$106.47	$873.43
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $331.10 / $637.15 / $3,087.45	Professional	TC	$331.10	$637.15	$3,087.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $459.12 / $783.36 / $1,263.81	Professional		$459.12	$783.36	$1,263.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.11 / $105.40 / $174.53	Professional	26	$64.11	$105.40	$174.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $391.96 / $674.48 / $1,089.28	Professional	TC	$391.96	$674.48	$1,089.28
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $58.19 / $101.52 / $188.57	Facility	26	$58.19	$101.52	$188.57
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $407.12 / $646.12 / $1,166.75	Professional		$407.12	$646.12	$1,166.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.87 / $86.83 / $159.49	Professional	26	$54.87	$86.83	$159.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $345.44 / $559.28 / $1,012.70	Professional	TC	$345.44	$559.28	$1,012.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $48.70 / $483.14 / $1,026.87	Professional		$48.70	$483.14	$1,026.87
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $91.14 / $114.57 / $119.68	Facility	26	$91.14	$114.57	$119.68
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $70.75 / $101.33 / $138.77	Professional	26	$70.75	$101.33	$138.77
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $404.49 / $623.40 / $793.37	Professional	TC	$404.49	$623.40	$793.37
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $79.28 / $79.28 / $79.52	Facility	26	$79.28	$79.28	$79.52
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $563.64 / $878.84 / $1,115.73	Professional		$563.64	$878.84	$1,115.73
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.93 / $129.50 / $157.84	Professional	26	$81.93	$129.50	$157.84
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $482.59 / $747.20 / $957.90	Professional	TC	$482.59	$747.20	$957.90
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $946.29 / $946.29 / $1,497.68	Facility	26	$946.29	$946.29	$1,497.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $392.35 / $430.50 / $920.16	Professional		$392.35	$430.50	$920.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.86 / $61.25 / $135.11	Professional	26	$57.86	$61.25	$135.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $331.10 / $351.12 / $654.50	Professional	TC	$331.10	$351.12	$654.50
United Facility/Professional Professional Modifier Low / Median / High Price $482.58 / $751.68 / $1,154.17	Professional		$482.58	$751.68	$1,154.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.65 / $116.68 / $173.26	Professional	26	$72.65	$116.68	$173.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $409.08 / $625.55 / $964.25	Professional	TC	$409.08	$625.55	$964.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $342.87 / $415.22 / $480.90	Professional		$342.87	$415.22	$480.90
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $47.76 / $56.52 / $60.47	Professional	26	$47.76	$56.52	$60.47
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $295.11 / $358.70 / $420.43	Professional	TC	$295.11	$358.70	$420.43