Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.53 / $117.01 / $217.17	Facility	26	$74.53	$117.01	$217.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $410.67 / $725.44	Professional		$275.00	$410.67	$725.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.39 / $83.00 / $177.38	Professional	26	$60.39	$83.00	$177.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $212.09 / $336.80 / $541.83	Professional	TC	$212.09	$336.80	$541.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $205.43 / $410.60 / $750.00	Professional		$205.43	$410.60	$750.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.38 / $113.22 / $176.12	Professional	26	$54.38	$113.22	$176.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $342.01 / $342.01 / $342.01	Professional	TC	$342.01	$342.01	$342.01
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $619.20 / $619.20 / $619.20	Facility	26	$619.20	$619.20	$619.20
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $379.61 / $676.36 / $2,385.40	Professional		$379.61	$676.36	$2,385.40
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.48 / $161.96 / $543.83	Professional	26	$91.48	$161.96	$543.83
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $292.45 / $516.24 / $2,603.00	Professional	TC	$292.45	$516.24	$2,603.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $272.37 / $519.66 / $902.16	Professional		$272.37	$519.66	$902.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.87 / $120.47 / $208.29	Professional	26	$65.87	$120.47	$208.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $201.05 / $425.54 / $723.71	Professional	TC	$201.05	$425.54	$723.71
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $149.32 / $539.79	Facility	26	$73.64	$149.32	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $270.48 / $581.04 / $1,049.45	Professional		$270.48	$581.04	$1,049.45
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $65.41 / $140.84 / $181.79	Professional	26	$65.41	$140.84	$181.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $232.99 / $454.29 / $863.46	Professional	TC	$232.99	$454.29	$863.46
Molina Facility/Professional Professional Modifier Low / Median / High Price $47.29 / $209.81 / $522.64	Professional		$47.29	$209.81	$522.64
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $107.73 / $129.41 / $134.00	Facility	26	$107.73	$129.41	$134.00
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $239.65 / $239.65 / $239.65	Professional		$239.65	$239.65	$239.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $91.63 / $117.41 / $150.69	Professional	26	$91.63	$117.41	$150.69
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $261.02 / $367.88 / $595.02	Professional	TC	$261.02	$367.88	$595.02
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $89.57 / $89.57 / $89.69	Facility	26	$89.57	$89.57	$89.69
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $423.06 / $635.42 / $768.26	Professional		$423.06	$635.42	$768.26
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $101.20 / $153.84 / $186.59	Professional	26	$101.20	$153.84	$186.59
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $320.55 / $481.10 / $581.66	Professional	TC	$320.55	$481.10	$581.66
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 $383.92 / $558.44 / $766.73	Professional		$383.92	$558.44	$766.73
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $91.48 / $135.63 / $183.94	Professional	26	$91.48	$135.63	$183.94
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $292.45 / $423.03 / $573.36	Professional	TC	$292.45	$423.03	$573.36
United Facility/Professional Professional Modifier Low / Median / High Price $240.81 / $372.10 / $779.94	Professional		$240.81	$372.10	$779.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.87 / $78.29 / $196.02	Professional	26	$60.87	$78.29	$196.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $179.76 / $304.70 / $625.86	Professional	TC	$179.76	$304.70	$625.86
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $285.43 / $285.43 / $285.43	Professional		$285.43	$285.43	$285.43
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $68.62 / $68.62 / $68.62	Professional	26	$68.62	$68.62	$68.62
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $216.81 / $216.81 / $216.81	Professional	TC	$216.81	$216.81	$216.81