Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.74 / $20.73 / $34.20	Facility	26	$15.74	$20.73	$34.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.09 / $119.40 / $262.32	Professional		$79.09	$119.40	$262.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $15.74 / $35.27	Professional	26	$11.48	$15.74	$35.27
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $39.54 / $59.70 / $285.48	Professional	52	$39.54	$59.70	$285.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.12 / $108.84 / $200.59	Professional	TC	$74.12	$108.84	$200.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $64.28 / $153.72 / $175.12	Professional		$64.28	$153.72	$175.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.92 / $18.00 / $21.21	Professional	26	$8.92	$18.00	$21.21
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $27.12 / $125.86 / $125.86	Facility	26	$27.12	$125.86	$125.86
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $116.19 / $210.77 / $768.54	Professional		$116.19	$210.77	$768.54
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.25 / $27.86 / $267.48	Professional	26	$16.25	$27.86	$267.48
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $6.59 / $6.59 / $6.59	Professional	52	$6.59	$6.59	$6.59
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $96.56 / $175.30 / $698.48	Professional	TC	$96.56	$175.30	$698.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $105.28 / $170.24 / $271.13	Professional		$105.28	$170.24	$271.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.16 / $21.76 / $37.75	Professional	26	$13.16	$21.76	$37.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $90.41 / $146.04 / $236.97	Professional	TC	$90.41	$146.04	$236.97
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $11.78 / $25.30 / $42.68	Facility	26	$11.78	$25.30	$42.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $100.78 / $183.42 / $271.87	Professional		$100.78	$183.42	$271.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.78 / $24.84 / $31.69	Professional	26	$11.78	$24.84	$31.69
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $90.14 / $157.32 / $237.18	Professional	TC	$90.14	$157.32	$237.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $18.27 / $106.52 / $185.08	Professional		$18.27	$106.52	$185.08
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $19.21 / $22.67 / $24.12	Facility	26	$19.21	$22.67	$24.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $16.42 / $20.50 / $25.38	Professional	26	$16.42	$20.50	$25.38
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $91.31 / $137.50 / $170.84	Professional	TC	$91.31	$137.50	$170.84
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $16.00 / $16.00 / $16.30	Facility	26	$16.00	$16.00	$16.30
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $126.81 / $188.29 / $231.51	Professional		$126.81	$188.29	$231.51
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.55 / $27.39 / $32.81	Professional	26	$18.55	$27.39	$32.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $108.26 / $164.09 / $198.71	Professional	TC	$108.26	$164.09	$198.71
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $217.18 / $217.18 / $354.01	Facility	26	$217.18	$217.18	$354.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $113.19 / $162.37 / $220.23	Professional		$113.19	$162.37	$220.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.63 / $23.01 / $30.99	Professional	26	$16.63	$23.01	$30.99
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $96.56 / $139.04 / $187.73	Professional	TC	$96.56	$139.04	$187.73
United Facility/Professional Professional Modifier Low / Median / High Price $96.75 / $163.76 / $241.09	Professional		$96.75	$163.76	$241.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.04 / $20.52 / $35.45	Professional	26	$14.04	$20.52	$35.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.69 / $142.77 / $204.93	Professional	TC	$85.69	$142.77	$204.93
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $94.66 / $94.66 / $94.66	Professional		$94.66	$94.66	$94.66
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $12.02 / $12.02	Professional	26	$12.02	$12.02	$12.02
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $82.63 / $82.63 / $82.63	Professional	TC	$82.63	$82.63	$82.63