Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.54 / $70.43 / $142.83	Facility	26	$53.54	$70.43	$142.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $159.38 / $248.29 / $458.57	Professional		$159.38	$248.29	$458.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.92 / $57.01 / $147.51	Professional	26	$45.92	$57.01	$147.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.49 / $191.04 / $306.32	Professional	TC	$102.49	$191.04	$306.32
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $103.32 / $263.54 / $400.00	Professional		$103.32	$263.54	$400.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.25 / $75.44 / $90.74	Professional	26	$39.25	$75.44	$90.74
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $442.24 / $442.24 / $442.24	Facility	26	$442.24	$442.24	$442.24
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $186.19 / $322.39 / $1,609.32	Professional		$186.19	$322.39	$1,609.32
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.14 / $116.69 / $388.43	Professional	26	$65.14	$116.69	$388.43
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $121.47 / $221.39 / $1,331.00	Professional	TC	$121.47	$221.39	$1,331.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $145.34 / $311.00 / $492.74	Professional		$145.34	$311.00	$492.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.19 / $90.96 / $154.12	Professional	26	$47.19	$90.96	$154.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.20 / $221.00 / $369.45	Professional	TC	$96.20	$221.00	$369.45
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $55.96 / $110.20 / $319.91	Facility	26	$55.96	$110.20	$319.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $182.73 / $353.22 / $628.84	Professional		$182.73	$353.22	$628.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.06 / $106.07 / $141.75	Professional	26	$50.06	$106.07	$141.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $140.32 / $254.67 / $496.32	Professional	TC	$140.32	$254.67	$496.32
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.33 / $149.27 / $312.59	Professional		$29.33	$149.27	$312.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $76.95 / $92.51 / $102.51	Facility	26	$76.95	$92.51	$102.51
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $86.94 / $86.94 / $86.94	Professional		$86.94	$86.94	$86.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $65.53 / $90.38 / $107.87	Professional	26	$65.53	$90.38	$107.87
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $154.97 / $236.16 / $345.10	Professional	TC	$154.97	$236.16	$345.10
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $63.87 / $63.87 / $63.98	Facility	26	$63.87	$63.87	$63.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $207.23 / $314.95 / $383.76	Professional		$207.23	$314.95	$383.76
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.17 / $108.36 / $131.97	Professional	26	$72.17	$108.36	$131.97
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $135.06 / $206.38 / $251.78	Professional	TC	$135.06	$206.38	$251.78
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 $186.19 / $276.80 / $410.60	Professional		$186.19	$276.80	$410.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.14 / $96.88 / $132.78	Professional	26	$65.14	$96.88	$132.78
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $121.04 / $179.92 / $277.68	Professional	TC	$121.04	$179.92	$277.68
United Facility/Professional Professional Modifier Low / Median / High Price $134.36 / $242.45 / $424.64	Professional		$134.36	$242.45	$424.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.56 / $58.10 / $138.33	Professional	26	$43.56	$58.10	$138.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.80 / $149.69 / $291.54	Professional	TC	$90.80	$149.69	$291.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $149.94 / $149.94 / $149.94	Professional		$149.94	$149.94	$149.94
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.05 / $49.05 / $49.05	Professional	26	$49.05	$49.05	$49.05
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $100.91 / $100.91 / $100.91	Professional	TC	$100.91	$100.91	$100.91