Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.33 / $133.00 / $249.00	Facility	26	$67.33	$133.00	$249.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $230.30 / $368.37 / $705.84	Professional		$230.30	$368.37	$705.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.44 / $69.00 / $168.60	Professional	26	$58.44	$69.00	$168.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.17 / $285.00 / $445.79	Professional	TC	$169.17	$285.00	$445.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $166.69 / $166.69 / $166.69	Professional		$166.69	$166.69	$166.69
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 $305.38 / $546.78 / $2,220.23	Professional		$305.38	$546.78	$2,220.23
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $82.70 / $149.19 / $590.91	Professional	26	$82.70	$149.19	$590.91
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $225.91 / $417.07 / $1,822.59	Professional	TC	$225.91	$417.07	$1,822.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $236.52 / $502.90 / $788.05	Professional		$236.52	$502.90	$788.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.58 / $120.14 / $195.68	Professional	26	$60.58	$120.14	$195.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $176.17 / $377.48 / $625.29	Professional	TC	$176.17	$377.48	$625.29
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $75.18 / $145.53 / $539.79	Facility	26	$75.18	$145.53	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $298.81 / $581.38 / $994.42	Professional		$298.81	$581.38	$994.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.27 / $136.01 / $180.00	Professional	26	$67.27	$136.01	$180.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $244.25 / $451.34 / $809.93	Professional	TC	$244.25	$451.34	$809.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $42.36 / $239.82 / $486.63	Professional		$42.36	$239.82	$486.63
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.83 / $117.40 / $138.02	Facility	26	$97.83	$117.40	$138.02
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $86.52 / $121.93 / $143.11	Professional	26	$86.52	$121.93	$143.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $280.24 / $411.52 / $539.28	Professional	TC	$280.24	$411.52	$539.28
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 $338.17 / $511.02 / $624.38	Professional		$338.17	$511.02	$624.38
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $92.27 / $138.93 / $166.84	Professional	26	$92.27	$138.93	$166.84
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $245.89 / $370.87 / $464.61	Professional	TC	$245.89	$370.87	$464.61
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 $305.38 / $449.11 / $666.20	Professional		$305.38	$449.11	$666.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $82.70 / $123.18 / $169.60	Professional	26	$82.70	$123.18	$169.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $222.68 / $325.93 / $483.48	Professional	TC	$222.68	$325.93	$483.48
United Facility/Professional Professional Modifier Low / Median / High Price $213.81 / $375.55 / $688.80	Professional		$213.81	$375.55	$688.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.91 / $77.52 / $172.38	Professional	26	$54.91	$77.52	$172.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.90 / $296.85 / $547.84	Professional	TC	$158.90	$296.85	$547.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $243.95 / $243.95 / $243.95	Professional		$243.95	$243.95	$243.95
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 $181.69 / $181.69 / $181.69	Professional	TC	$181.69	$181.69	$181.69