Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.60 / $78.27 / $124.40	Facility	26	$58.60	$78.27	$124.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.00 / $134.58 / $372.94	Professional		$84.00	$134.58	$372.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.29 / $53.20 / $108.23	Professional	26	$40.29	$53.20	$108.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.04 / $56.77 / $113.97	Professional	TC	$40.04	$56.77	$113.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.05 / $148.88 / $197.82	Professional		$93.05	$148.88	$197.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.60 / $58.85 / $87.34	Professional	26	$43.60	$58.85	$87.34
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $279.14 / $279.14 / $279.14	Professional	50	$279.14	$279.14	$279.14
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $60.32 / $201.33 / $201.33	Facility	26	$60.32	$201.33	$201.33
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $106.00 / $195.49 / $820.35	Professional		$106.00	$195.49	$820.35
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.25 / $91.49 / $366.23	Professional	26	$50.25	$91.49	$366.23
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $149.13 / $290.54 / $423.86	Professional	50	$149.13	$290.54	$423.86
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.44 / $106.86 / $454.13	Professional	TC	$59.44	$106.86	$454.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.44 / $158.41 / $294.25	Professional		$91.44	$158.41	$294.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.65 / $79.63 / $132.97	Professional	26	$48.65	$79.63	$132.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.05 / $86.24 / $161.30	Professional	TC	$46.05	$86.24	$161.30
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $40.92 / $71.01 / $114.90	Facility	26	$40.92	$71.01	$114.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $80.36 / $126.69 / $235.30	Professional		$80.36	$126.69	$235.30
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.19 / $61.79 / $109.23	Professional	26	$38.19	$61.79	$109.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $40.36 / $65.27 / $123.80	Professional	TC	$40.36	$65.27	$123.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.78 / $70.11 / $224.30	Professional		$15.78	$70.11	$224.30
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $64.68 / $87.98 / $88.44	Facility	26	$64.68	$87.98	$88.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $53.47 / $72.59 / $93.72	Professional	26	$53.47	$72.59	$93.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $60.48 / $84.42 / $100.64	Professional	TC	$60.48	$84.42	$100.64
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $60.25 / $60.25 / $60.32	Facility	26	$60.25	$60.25	$60.32
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $135.61 / $217.76 / $264.79	Professional		$135.61	$217.76	$264.79
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.99 / $99.52 / $121.12	Professional	26	$62.99	$99.52	$121.12
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.75 / $118.23 / $146.22	Professional	TC	$74.75	$118.23	$146.22
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $137.68 / $187.34 / $255.02	Professional		$137.68	$187.34	$255.02
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $61.45 / $85.86 / $116.89	Professional	26	$61.45	$85.86	$116.89
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $76.23 / $101.47 / $138.10	Professional	TC	$76.23	$101.47	$138.10
United Facility/Professional Professional Modifier Low / Median / High Price $112.30 / $172.18 / $280.95	Professional		$112.30	$172.18	$280.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.78 / $79.06 / $129.47	Professional	26	$52.78	$79.06	$129.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.56 / $84.30 / $150.10	Professional	TC	$55.56	$84.30	$150.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $77.30 / $93.05 / $105.22	Professional		$77.30	$93.05	$105.22
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $36.72 / $43.59 / $47.21	Professional	26	$36.72	$43.59	$47.21
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $40.58 / $49.45 / $58.01	Professional	TC	$40.58	$49.45	$58.01