Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $93.43 / $161.11 / $645.79	Facility		$93.43	$161.11	$645.79
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.89 / $32.14 / $50.13	Facility	26	$23.89	$32.14	$50.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.18 / $111.62 / $185.91	Professional		$61.18	$111.62	$185.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.90 / $19.50 / $35.53	Professional	26	$15.90	$19.50	$35.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.83 / $86.85 / $160.25	Professional	TC	$43.83	$86.85	$160.25
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $349.02 / $827.51 / $1,202.01	Facility		$349.02	$827.51	$1,202.01
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $24.68 / $134.26 / $134.26	Facility	26	$24.68	$134.26	$134.26
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $87.47 / $145.22 / $803.55	Professional		$87.47	$145.22	$803.55
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.21 / $37.22 / $416.07	Professional	26	$21.21	$37.22	$416.07
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.29 / $103.69 / $567.25	Professional	TC	$58.29	$103.69	$567.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.01 / $131.28 / $235.09	Professional		$83.01	$131.28	$235.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.84 / $32.42 / $54.45	Professional	26	$18.84	$32.42	$54.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.27 / $102.99 / $178.81	Professional	TC	$58.27	$102.99	$178.81
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $75.04 / $144.04 / $375.27	Facility		$75.04	$144.04	$375.27
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $15.64 / $26.49 / $46.30	Facility	26	$15.64	$26.49	$46.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $62.58 / $109.00 / $254.49	Professional		$62.58	$109.00	$254.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.36 / $24.53 / $43.06	Professional	26	$15.36	$24.53	$43.06
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.20 / $84.01 / $215.16	Professional	TC	$46.20	$84.01	$215.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.83 / $71.03 / $162.64	Professional		$14.83	$71.03	$162.64
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $108.88 / $135.34 / $250.58	Facility		$108.88	$135.34	$250.58
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $25.97 / $35.51 / $36.18	Facility	26	$25.97	$35.51	$36.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $23.97 / $30.50 / $39.96	Professional	26	$23.97	$30.50	$39.96
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $77.14 / $151.02 / $215.74	Professional	TC	$77.14	$151.02	$215.74
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $87.88 / $92.31 / $443.08	Facility		$87.88	$92.31	$443.08
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $24.46 / $24.46 / $24.68	Facility	26	$24.46	$24.46	$24.68
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.02 / $150.66 / $183.23	Professional		$95.02	$150.66	$183.23
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.57 / $40.40 / $49.18	Professional	26	$25.57	$40.40	$49.18
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.62 / $109.57 / $134.25	Professional	TC	$69.62	$109.57	$134.25
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $535.59 / $869.76 / $1,701.50	Facility		$535.59	$869.76	$1,701.50
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $459.43 / $459.43 / $513.03	Facility	26	$459.43	$459.43	$513.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $89.63 / $131.10 / $178.87	Professional		$89.63	$131.10	$178.87
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $24.95 / $35.13 / $47.57	Professional	26	$24.95	$35.13	$47.57
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $64.68 / $95.34 / $131.05	Professional	TC	$64.68	$95.34	$131.05
United Facility/Professional Professional Modifier Low / Median / High Price $78.95 / $139.38 / $199.20	Professional		$78.95	$139.38	$199.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.26 / $30.17 / $52.38	Professional	26	$22.26	$30.17	$52.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.70 / $107.42 / $151.38	Professional	TC	$56.70	$107.42	$151.38
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $54.66 / $66.08 / $75.89	Professional		$54.66	$66.08	$75.89
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $14.91 / $17.72 / $19.19	Professional	26	$14.91	$17.72	$19.19
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $39.75 / $48.37 / $56.71	Professional	TC	$39.75	$48.37	$56.71