Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.17 / $48.64 / $107.90	Facility	26	$37.17	$48.64	$107.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.32 / $138.41 / $630.00	Professional		$102.32	$138.41	$630.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $47.89 / $135.00	Professional	26	$29.75	$47.89	$135.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.65 / $102.17 / $262.79	Professional	TC	$74.65	$102.17	$262.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $86.31 / $167.22 / $224.42	Professional		$86.31	$167.22	$224.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.20 / $52.24 / $58.57	Professional	26	$24.20	$52.24	$58.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $37.14 / $116.56 / $170.80	Professional	TC	$37.14	$116.56	$170.80
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $77.02 / $146.86 / $171.00	Facility	26	$77.02	$146.86	$171.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $147.38 / $271.44 / $907.35	Professional		$147.38	$271.44	$907.35
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.28 / $81.70 / $265.73	Professional	26	$45.28	$81.70	$265.73
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $102.10 / $187.72 / $641.63	Professional	TC	$102.10	$187.72	$641.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $121.24 / $199.53 / $341.66	Professional		$121.24	$199.53	$341.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.97 / $60.06 / $99.32	Professional	26	$35.97	$60.06	$99.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $86.78 / $142.66 / $240.98	Professional	TC	$86.78	$142.66	$240.98
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $31.93 / $68.89 / $115.69	Facility	26	$31.93	$68.89	$115.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $116.56 / $225.18 / $314.74	Professional		$116.56	$225.18	$314.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.93 / $68.34 / $86.28	Professional	26	$31.93	$68.34	$86.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $86.49 / $161.32 / $221.48	Professional	TC	$86.49	$161.32	$221.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.11 / $100.68 / $228.14	Professional		$21.11	$100.68	$228.14
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $52.80 / $64.04 / $66.33	Facility	26	$52.80	$64.04	$66.33
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $78.25 / $86.94	Professional		$78.25	$78.25	$86.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $41.58 / $55.31 / $71.54	Professional	26	$41.58	$55.31	$71.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $95.99 / $129.55 / $166.37	Professional	TC	$95.99	$129.55	$166.37
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $43.87 / $43.87 / $44.39	Facility	26	$43.87	$43.87	$44.39
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $163.93 / $241.97 / $296.19	Professional		$163.93	$241.97	$296.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.52 / $74.56 / $89.98	Professional	26	$50.52	$74.56	$89.98
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $113.41 / $167.71 / $206.21	Professional	TC	$113.41	$167.71	$206.21
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 $147.38 / $210.55 / $283.83	Professional		$147.38	$210.55	$283.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $45.28 / $65.18 / $86.33	Professional	26	$45.28	$65.18	$86.33
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $102.10 / $146.32 / $197.60	Professional	TC	$102.10	$146.32	$197.60
United Facility/Professional Professional Modifier Low / Median / High Price $111.52 / $122.04 / $290.97	Professional		$111.52	$122.04	$290.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.97 / $38.03 / $93.11	Professional	26	$34.97	$38.03	$93.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $76.51 / $85.12 / $208.99	Professional	TC	$76.51	$85.12	$208.99
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $119.37 / $119.37 / $119.37	Professional		$119.37	$119.37	$119.37
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.97 / $33.97 / $33.97	Professional	26	$33.97	$33.97	$33.97
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $85.40 / $85.40 / $85.40	Professional	TC	$85.40	$85.40	$85.40