Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $115.18 / $188.67 / $335.08	Facility	26	$115.18	$188.67	$335.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $371.24 / $522.50 / $1,324.05	Professional		$371.24	$522.50	$1,324.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $145.65 / $371.20	Professional	26	$104.00	$145.65	$371.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.41 / $357.87 / $839.63	Professional	TC	$281.41	$357.87	$839.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $267.82 / $644.16 / $1,014.62	Professional		$267.82	$644.16	$1,014.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $159.02 / $175.94 / $197.27	Professional	26	$159.02	$175.94	$197.27
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $950.80 / $950.80 / $950.80	Facility	26	$950.80	$950.80	$950.80
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $483.80 / $839.31 / $5,978.92	Professional		$483.80	$839.31	$5,978.92
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $139.52 / $249.37 / $835.43	Professional	26	$139.52	$249.37	$835.43
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $353.89 / $637.74 / $5,438.76	Professional	TC	$353.89	$637.74	$5,438.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $381.15 / $751.95 / $1,359.47	Professional		$381.15	$751.95	$1,359.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.66 / $184.10 / $319.81	Professional	26	$100.66	$184.10	$319.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $275.10 / $591.19 / $1,060.45	Professional	TC	$275.10	$591.19	$1,060.45
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $112.30 / $230.09 / $1,102.78	Facility	26	$112.30	$230.09	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $507.27 / $929.07 / $1,822.06	Professional		$507.27	$929.07	$1,822.06
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $99.51 / $214.78 / $279.54	Professional	26	$99.51	$214.78	$279.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $386.20 / $696.42 / $1,583.01	Professional	TC	$386.20	$696.42	$1,583.01
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 $154.35 / $200.75 / $205.69	Facility	26	$154.35	$200.75	$205.69
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $298.17 / $298.17 / $298.17	Professional		$298.17	$298.17	$298.17
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $122.80 / $173.28 / $226.50	Professional	26	$122.80	$173.28	$226.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $435.29 / $591.66 / $875.36	Professional	TC	$435.29	$591.66	$875.36
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $136.81 / $136.81 / $137.56	Facility	26	$136.81	$136.81	$137.56
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $545.40 / $818.90 / $1,043.64	Professional		$545.40	$818.90	$1,043.64
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $156.71 / $232.97 / $283.61	Professional	26	$156.71	$232.97	$283.61
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $388.69 / $593.92 / $759.23	Professional	TC	$388.69	$593.92	$759.23
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $1,538.06	Facility	26	$714.15	$714.15	$1,538.06
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $493.42 / $719.68 / $1,079.75	Professional		$493.42	$719.68	$1,079.75
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $139.52 / $208.29 / $280.51	Professional	26	$139.52	$208.29	$280.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $353.89 / $511.92 / $789.25	Professional	TC	$353.89	$511.92	$789.25
United Facility/Professional Professional Modifier Low / Median / High Price $336.82 / $691.74 / $1,143.63	Professional		$336.82	$691.74	$1,143.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $92.95 / $114.24 / $299.44	Professional	26	$92.95	$114.24	$299.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $243.87 / $513.55 / $891.49	Professional	TC	$243.87	$513.55	$891.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $390.40 / $390.40 / $390.40	Professional		$390.40	$390.40	$390.40
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $106.63 / $106.63 / $106.63	Professional	26	$106.63	$106.63	$106.63
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $283.77 / $283.77 / $283.77	Professional	TC	$283.77	$283.77	$283.77