Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.12 / $112.91 / $200.53	Facility	26	$68.12	$112.91	$200.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $184.01 / $263.63 / $485.52	Professional		$184.01	$263.63	$485.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.15 / $73.51 / $162.74	Professional	26	$55.15	$73.51	$162.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.69 / $197.71 / $308.00	Professional	TC	$112.69	$197.71	$308.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $119.49 / $119.49 / $119.49	Professional		$119.49	$119.49	$119.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.01 / $94.50 / $97.45	Professional	26	$48.01	$94.50	$97.45
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $568.24 / $568.24 / $568.24	Facility	26	$568.24	$568.24	$568.24
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $215.29 / $386.18 / $1,403.43	Professional		$215.29	$386.18	$1,403.43
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.62 / $147.71 / $500.25	Professional	26	$83.62	$147.71	$500.25
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.66 / $236.71 / $1,332.00	Professional	TC	$131.66	$236.71	$1,332.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $166.92 / $330.40 / $531.76	Professional		$166.92	$330.40	$531.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.36 / $110.13 / $191.17	Professional	26	$60.36	$110.13	$191.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $103.03 / $203.35 / $353.04	Professional	TC	$103.03	$203.35	$353.04
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $67.38 / $137.63 / $319.91	Facility	26	$67.38	$137.63	$319.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $176.36 / $366.57 / $657.89	Professional		$176.36	$366.57	$657.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.83 / $128.86 / $167.06	Professional	26	$59.83	$128.86	$167.06
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $125.62 / $240.25 / $466.69	Professional	TC	$125.62	$240.25	$466.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.46 / $149.27 / $312.59	Professional		$29.46	$149.27	$312.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $99.00 / $119.39 / $122.61	Facility	26	$99.00	$119.39	$122.61
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $85.83 / $117.00 / $127.34	Professional	26	$85.83	$117.00	$127.34
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $141.19 / $229.87 / $343.04	Professional	TC	$141.19	$229.87	$343.04
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $81.99 / $81.99 / $82.26	Facility	26	$81.99	$81.99	$82.26
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $240.22 / $362.99 / $438.87	Professional		$240.22	$362.99	$438.87
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.49 / $140.50 / $168.71	Professional	26	$93.49	$140.50	$168.71
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $146.40 / $221.26 / $270.31	Professional	TC	$146.40	$221.26	$270.31
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $215.29 / $319.01 / $437.78	Professional		$215.29	$319.01	$437.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.62 / $124.56 / $168.31	Professional	26	$83.62	$124.56	$168.31
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $131.66 / $194.45 / $269.47	Professional	TC	$131.66	$194.45	$269.47
United Facility/Professional Professional Modifier Low / Median / High Price $142.03 / $236.36 / $457.54	Professional		$142.03	$236.36	$457.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.79 / $72.15 / $179.85	Professional	26	$55.79	$72.15	$179.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.20 / $173.65 / $288.11	Professional	TC	$86.20	$173.65	$288.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $172.19 / $172.19 / $172.19	Professional		$172.19	$172.19	$172.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $63.39 / $63.39 / $63.39	Professional	26	$63.39	$63.39	$63.39
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $108.80 / $108.80 / $108.80	Professional	TC	$108.80	$108.80	$108.80