Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.76 / $133.76 / $218.86	Facility	26	$67.76	$133.76	$218.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $221.90 / $349.43 / $634.57	Professional		$221.90	$349.43	$634.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.97 / $72.30 / $144.44	Professional	26	$60.97	$72.30	$144.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $152.90 / $285.00 / $526.21	Professional	TC	$152.90	$285.00	$526.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $73.14 / $73.14 / $73.14	Professional		$73.14	$73.14	$73.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.06 / $33.06 / $33.06	Professional	26	$33.06	$33.06	$33.06
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $561.91 / $561.91 / $561.91	Facility	26	$561.91	$561.91	$561.91
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $266.57 / $479.26 / $2,075.08	Professional		$266.57	$479.26	$2,075.08
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $82.70 / $149.49 / $494.70	Professional	26	$82.70	$149.49	$494.70
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $183.90 / $349.40 / $1,685.33	Professional	TC	$183.90	$349.40	$1,685.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $202.92 / $408.35 / $689.96	Professional		$202.92	$408.35	$689.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.81 / $110.65 / $195.68	Professional	26	$59.81	$110.65	$195.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $139.75 / $284.10 / $503.17	Professional	TC	$139.75	$284.10	$503.17
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $66.64 / $138.51 / $539.79	Facility	26	$66.64	$138.51	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $247.00 / $469.97 / $911.17	Professional		$247.00	$469.97	$911.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.31 / $133.94 / $172.97	Professional	26	$62.31	$133.94	$172.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $170.18 / $334.39 / $749.02	Professional	TC	$170.18	$334.39	$749.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.11 / $194.07 / $399.31	Professional		$36.11	$194.07	$399.31
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.83 / $117.40 / $127.44	Facility	26	$97.83	$117.40	$127.44
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $247.14 / $247.14 / $247.14	Professional		$247.14	$247.14	$247.14
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $83.26 / $114.57 / $133.94	Professional	26	$83.26	$114.57	$133.94
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $185.72 / $290.82 / $567.00	Professional	TC	$185.72	$290.82	$567.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $81.09 / $81.09 / $81.34	Facility	26	$81.09	$81.09	$81.34
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $296.41 / $446.46 / $547.29	Professional		$296.41	$446.46	$547.29
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $92.79 / $139.71 / $166.84	Professional	26	$92.79	$139.71	$166.84
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $203.62 / $306.30 / $384.70	Professional	TC	$203.62	$306.30	$384.70
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $346.39 / $851.78	Facility	26	$346.39	$346.39	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $266.57 / $392.36 / $543.36	Professional		$266.57	$392.36	$543.36
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $82.70 / $123.18 / $166.47	Professional	26	$82.70	$123.18	$166.47
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $183.88 / $269.19 / $374.80	Professional	TC	$183.88	$269.19	$374.80
United Facility/Professional Professional Modifier Low / Median / High Price $175.77 / $351.02 / $583.33	Professional		$175.77	$351.02	$583.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.22 / $72.01 / $172.14	Professional	26	$55.22	$72.01	$172.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.55 / $227.02 / $400.71	Professional	TC	$120.55	$227.02	$400.71
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $212.77 / $212.77 / $212.77	Professional		$212.77	$212.77	$212.77
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $62.26 / $62.26 / $62.26	Professional	26	$62.26	$62.26	$62.26
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $150.51 / $150.51 / $150.51	Professional	TC	$150.51	$150.51	$150.51