Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.64 / $119.71 / $314.47	Facility	26	$97.64	$119.71	$314.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $306.68 / $401.19 / $975.60	Professional		$306.68	$401.19	$975.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $80.45 / $108.17 / $308.52	Professional	26	$80.45	$108.17	$308.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $303.55 / $580.34	Professional	TC	$229.09	$303.55	$580.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $305.37 / $578.85 / $884.43	Professional		$305.37	$578.85	$884.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.08 / $138.72 / $148.85	Professional	26	$84.08	$138.72	$148.85
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $198.32 / $244.43 / $482.13	Professional	TC	$198.32	$244.43	$482.13
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $805.76 / $805.76	Facility	26	$714.15	$805.76	$805.76
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $426.84 / $755.22 / $2,686.43	Professional		$426.84	$755.22	$2,686.43
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $118.73 / $208.71 / $707.40	Professional	26	$118.73	$208.71	$707.40
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $326.17 / $546.66 / $2,614.00	Professional	TC	$326.17	$546.66	$2,614.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $309.75 / $573.23 / $1,015.04	Professional		$309.75	$573.23	$1,015.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.05 / $157.56 / $280.77	Professional	26	$86.05	$157.56	$280.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $219.32 / $435.70 / $760.47	Professional	TC	$219.32	$435.70	$760.47
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $95.73 / $195.56 / $1,094.31	Facility	26	$95.73	$195.56	$1,094.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $321.47 / $680.35 / $912.14	Professional		$321.47	$680.35	$912.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.94 / $183.09 / $237.21	Professional	26	$84.94	$183.09	$237.21
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $241.49 / $481.37 / $685.16	Professional	TC	$241.49	$481.37	$685.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $66.58 / $291.45 / $683.79	Professional		$66.58	$291.45	$683.79
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $140.25 / $169.85 / $174.20	Facility	26	$140.25	$169.85	$174.20
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $268.35 / $268.35	Professional		$268.35	$268.35	$268.35
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $118.56 / $154.97 / $183.35	Professional	26	$118.56	$154.97	$183.35
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $293.89 / $400.16 / $504.35	Professional	TC	$293.89	$400.16	$504.35
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $116.42 / $116.42 / $116.54	Facility	26	$116.42	$116.42	$116.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $490.76 / $734.50 / $889.17	Professional		$490.76	$734.50	$889.17
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $133.00 / $200.53 / $240.55	Professional	26	$133.00	$200.53	$240.55
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $356.51 / $533.97 / $646.41	Professional	TC	$356.51	$533.97	$646.41
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $851.78	Facility	26	$714.15	$714.15	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $444.91 / $646.33 / $868.56	Professional		$444.91	$646.33	$868.56
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $118.73 / $176.46 / $239.12	Professional	26	$118.73	$176.46	$239.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $326.17 / $477.26 / $637.16	Professional	TC	$326.17	$477.26	$637.16
United Facility/Professional Professional Modifier Low / Median / High Price $282.52 / $398.30 / $904.41	Professional		$282.52	$398.30	$904.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.45 / $103.60 / $252.28	Professional	26	$79.45	$103.60	$252.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $203.08 / $250.87 / $659.31	Professional	TC	$203.08	$250.87	$659.31
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $350.82 / $350.82 / $350.82	Professional		$350.82	$350.82	$350.82
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $90.21 / $90.21 / $90.21	Professional	26	$90.21	$90.21	$90.21
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $260.61 / $260.61 / $260.61	Professional	TC	$260.61	$260.61	$260.61