Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.72 / $153.26 / $280.62	Facility	26	$87.72	$153.26	$280.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $362.47 / $475.00 / $1,045.73	Professional		$362.47	$475.00	$1,045.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.00 / $140.00 / $246.35	Professional	26	$85.00	$140.00	$246.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $276.04 / $347.32 / $756.84	Professional	TC	$276.04	$347.32	$756.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $246.13 / $589.82 / $598.05	Professional		$246.13	$589.82	$598.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $59.82 / $123.37 / $123.37	Professional	26	$59.82	$123.37	$123.37
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $165.74 / $165.74 / $165.74	Professional	TC	$165.74	$165.74	$165.74
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $723.52 / $723.52 / $723.52	Facility	26	$723.52	$723.52	$723.52
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $460.61 / $779.81 / $3,348.15	Professional		$460.61	$779.81	$3,348.15
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $106.72 / $190.75 / $635.54	Professional	26	$106.72	$190.75	$635.54
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $353.89 / $631.24 / $2,941.88	Professional	TC	$353.89	$631.24	$2,941.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $346.59 / $681.13 / $1,141.66	Professional		$346.59	$681.13	$1,141.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.87 / $140.06 / $243.46	Professional	26	$76.87	$140.06	$243.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $270.55 / $539.28 / $885.86	Professional	TC	$270.55	$539.28	$885.86
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $85.42 / $174.33 / $2,217.21	Facility	26	$85.42	$174.33	$2,217.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $407.03 / $813.63 / $1,322.97	Professional		$407.03	$813.63	$1,322.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.95 / $163.37 / $211.80	Professional	26	$75.95	$163.37	$211.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $335.73 / $652.03 / $1,112.00	Professional	TC	$335.73	$652.03	$1,112.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $66.21 / $300.95 / $745.03	Professional		$66.21	$300.95	$745.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $117.11 / $151.19 / $155.44	Facility	26	$117.11	$151.19	$155.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $93.26 / $132.24 / $162.25	Professional	26	$93.26	$132.24	$162.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $348.94 / $512.12 / $771.98	Professional	TC	$348.94	$512.12	$771.98
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $104.64 / $104.64 / $104.65	Facility	26	$104.64	$104.64	$104.65
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $506.74 / $761.42 / $935.62	Professional		$506.74	$761.42	$935.62
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $118.57 / $180.09 / $218.01	Professional	26	$118.57	$180.09	$218.01
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $388.17 / $582.83 / $741.84	Professional	TC	$388.17	$582.83	$741.84
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,387.45 / $1,387.45 / $2,298.07	Facility	26	$1,387.45	$1,387.45	$2,298.07
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $460.61 / $669.16 / $988.68	Professional		$460.61	$669.16	$988.68
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $106.72 / $158.47 / $213.37	Professional	26	$106.72	$158.47	$213.37
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $353.89 / $511.92 / $757.56	Professional	TC	$353.89	$511.92	$757.56
United Facility/Professional Professional Modifier Low / Median / High Price $315.66 / $499.39 / $1,016.91	Professional		$315.66	$499.39	$1,016.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.86 / $91.48 / $225.99	Professional	26	$70.86	$91.48	$225.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $244.49 / $429.49 / $776.33	Professional	TC	$244.49	$429.49	$776.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $362.46 / $362.46 / $362.46	Professional		$362.46	$362.46	$362.46
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Professional	26	$80.26	$80.26	$80.26
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $282.20 / $282.20 / $282.20	Professional	TC	$282.20	$282.20	$282.20