Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.00 / $270.56 / $441.85	Facility	26	$138.00	$270.56	$441.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $402.08 / $498.49 / $1,176.55	Professional		$402.08	$498.49	$1,176.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $145.65 / $389.04	Professional	26	$104.00	$145.65	$389.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $282.61 / $360.49 / $787.51	Professional	TC	$282.61	$360.49	$787.51
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $286.44 / $682.76 / $770.04	Professional		$286.44	$682.76	$770.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $195.95 / $235.56 / $326.19	Professional	26	$195.95	$235.56	$326.19
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $1,142.00 / $1,142.00	Facility	26	$714.15	$1,142.00	$1,142.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $535.46 / $900.84 / $3,919.13	Professional		$535.46	$900.84	$3,919.13
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $167.24 / $301.29 / $998.78	Professional	26	$167.24	$301.29	$998.78
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $368.21 / $645.96 / $3,292.02	Professional	TC	$368.21	$645.96	$3,292.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $401.86 / $773.35 / $1,315.82	Professional		$401.86	$773.35	$1,315.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $119.96 / $221.43 / $384.04	Professional	26	$119.96	$221.43	$384.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $275.81 / $555.04 / $951.26	Professional	TC	$275.81	$555.04	$951.26
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $122.34 / $275.91 / $1,002.46	Facility	26	$122.34	$275.91	$1,002.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $449.81 / $930.81 / $1,528.49	Professional		$449.81	$930.81	$1,528.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $119.52 / $255.62 / $334.42	Professional	26	$119.52	$255.62	$334.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $336.97 / $669.63 / $1,202.29	Professional	TC	$336.97	$669.63	$1,202.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $67.31 / $338.47 / $798.39	Professional		$67.31	$338.47	$798.39
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $198.55 / $240.15 / $246.16	Facility	26	$198.55	$240.15	$246.16
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 $145.52 / $210.54 / $262.26	Professional	26	$145.52	$210.54	$262.26
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $334.00 / $497.06 / $813.16	Professional	TC	$334.00	$497.06	$813.16
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $163.99 / $163.99 / $164.98	Facility	26	$163.99	$163.99	$164.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $586.64 / $882.68 / $1,083.15	Professional		$586.64	$882.68	$1,083.15
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $187.13 / $279.41 / $339.77	Professional	26	$187.13	$279.41	$339.77
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $399.51 / $604.91 / $763.95	Professional	TC	$399.51	$604.91	$763.95
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 $535.46 / $775.73 / $1,130.31	Professional		$535.46	$775.73	$1,130.31
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $167.24 / $249.81 / $333.85	Professional	26	$167.24	$249.81	$333.85
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $368.21 / $532.64 / $780.14	Professional	TC	$368.21	$532.64	$780.14
United Facility/Professional Professional Modifier Low / Median / High Price $362.59 / $622.94 / $1,168.11	Professional		$362.59	$622.94	$1,168.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $110.74 / $137.18 / $355.58	Professional	26	$110.74	$137.18	$355.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $251.85 / $474.87 / $816.86	Professional	TC	$251.85	$474.87	$816.86
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $416.24 / $416.24 / $416.24	Professional		$416.24	$416.24	$416.24
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $127.33 / $127.33 / $127.33	Professional	26	$127.33	$127.33	$127.33
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $288.91 / $288.91 / $288.91	Professional	TC	$288.91	$288.91	$288.91