Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.60 / $79.54 / $130.63	Facility	26	$40.60	$79.54	$130.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.53 / $188.61 / $434.79	Professional		$133.53	$188.61	$434.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.23 / $40.60 / $112.39	Professional	26	$31.23	$40.60	$112.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $104.34 / $148.01 / $323.93	Professional	TC	$104.34	$148.01	$323.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $57.55 / $59.22 / $61.71	Professional	26	$57.55	$59.22	$61.71
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $80.00 / $161.97 / $161.97	Facility	26	$80.00	$161.97	$161.97
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $207.02 / $371.74 / $1,274.84	Professional		$207.02	$371.74	$1,274.84
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.43 / $88.92 / $294.30	Professional	26	$49.43	$88.92	$294.30
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.00 / $281.37 / $980.55	Professional	TC	$158.00	$281.37	$980.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $160.11 / $276.83 / $480.50	Professional		$160.11	$276.83	$480.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.65 / $65.73 / $109.76	Professional	26	$39.65	$65.73	$109.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $119.52 / $211.05 / $374.14	Professional	TC	$119.52	$211.05	$374.14
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $35.34 / $75.92 / $128.04	Facility	26	$35.34	$75.92	$128.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $155.62 / $305.31 / $415.40	Professional		$155.62	$305.31	$415.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.34 / $75.19 / $95.09	Professional	26	$35.34	$75.19	$95.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $118.18 / $226.25 / $321.07	Professional	TC	$118.18	$226.25	$321.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.15 / $151.38 / $373.59	Professional		$29.15	$151.38	$373.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $58.30 / $70.48 / $72.79	Facility	26	$58.30	$70.48	$72.79
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $43.42 / $60.87 / $75.20	Professional	26	$43.42	$60.87	$75.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $135.88 / $182.52 / $233.22	Professional	TC	$135.88	$182.52	$233.22
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $48.44 / $48.44 / $48.47	Facility	26	$48.44	$48.44	$48.47
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $229.91 / $339.36 / $414.29	Professional		$229.91	$339.36	$414.29
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.16 / $81.42 / $99.35	Professional	26	$55.16	$81.42	$99.35
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $174.75 / $257.95 / $314.93	Professional	TC	$174.75	$257.95	$314.93
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $207.44 / $295.30 / $397.00	Professional		$207.44	$295.30	$397.00
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.43 / $71.17 / $95.21	Professional	26	$49.43	$71.17	$95.21
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $158.00 / $225.47 / $305.82	Professional	TC	$158.00	$225.47	$305.82
United Facility/Professional Professional Modifier Low / Median / High Price $146.11 / $166.25 / $415.27	Professional		$146.11	$166.25	$415.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.59 / $40.02 / $101.65	Professional	26	$38.59	$40.02	$101.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $106.04 / $126.36 / $322.06	Professional	TC	$106.04	$126.36	$322.06
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $167.78 / $167.78 / $167.78	Professional		$167.78	$167.78	$167.78
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.40 / $37.40 / $37.40	Professional	26	$37.40	$37.40	$37.40
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $130.38 / $130.38 / $130.38	Professional	TC	$130.38	$130.38	$130.38