Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.63 / $20.74 / $33.84	Facility	26	$10.63	$20.74	$33.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.62 / $65.34 / $288.58	Professional		$26.62	$65.34	$288.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.83 / $11.37 / $54.34	Professional	26	$8.83	$11.37	$54.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.00 / $56.50 / $192.00	Professional	TC	$16.00	$56.50	$192.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $47.76 / $47.76 / $53.65	Professional		$47.76	$47.76	$53.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.44 / $16.14 / $18.11	Professional	26	$7.44	$16.14	$18.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $38.44 / $38.44 / $38.44	Professional	TC	$38.44	$38.44	$38.44
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $80.00 / $100.00 / $132.00	Facility	26	$80.00	$100.00	$132.00
Asuris Northwest Health Facility/Professional Facility Modifier 53 Low / Median / High Price $10.23 / $53.18 / $53.18	Facility	53	$10.23	$53.18	$53.18
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $31.42 / $57.74 / $761.56	Professional		$31.42	$57.74	$761.56
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.94 / $22.16 / $132.00	Professional	26	$12.94	$22.16	$132.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.48 / $36.93 / $705.08	Professional	TC	$21.48	$36.93	$705.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.56 / $51.40 / $121.68	Professional		$27.56	$51.40	$121.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.19 / $17.12 / $28.40	Professional	26	$10.19	$17.12	$28.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.94 / $32.79 / $109.48	Professional	TC	$15.94	$32.79	$109.48
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $11.25 / $19.68 / $25.84	Facility	26	$11.25	$19.68	$25.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $28.01 / $58.11 / $176.14	Professional		$28.01	$58.11	$176.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.30 / $20.46 / $25.72	Professional	26	$10.30	$20.46	$25.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $16.12 / $35.58 / $152.13	Professional	TC	$16.12	$35.58	$152.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.04 / $54.27 / $92.00	Professional		$9.04	$54.27	$92.00
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.84 / $18.46 / $19.04	Facility	26	$14.84	$18.46	$19.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.26 / $15.71 / $20.29	Professional	26	$11.26	$15.71	$20.29
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $17.82 / $26.09 / $94.62	Professional	TC	$17.82	$26.09	$94.62
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $12.68 / $12.68 / $12.80	Facility	26	$12.68	$12.68	$12.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.11 / $56.71 / $71.40	Professional		$37.11	$56.71	$71.40
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.43 / $21.67 / $26.24	Professional	26	$14.43	$21.67	$26.24
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.68 / $34.17 / $44.74	Professional	TC	$22.68	$34.17	$44.74
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $32.64 / $49.31 / $67.36	Professional		$32.64	$49.31	$67.36
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.94 / $19.38 / $25.75	Professional	26	$12.94	$19.38	$25.75
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $19.07 / $30.57 / $42.22	Professional	TC	$19.07	$30.57	$42.22
United Facility/Professional Professional Modifier Low / Median / High Price $19.94 / $41.06 / $89.71	Professional		$19.94	$41.06	$89.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.59 / $11.18 / $26.79	Professional	26	$8.59	$11.18	$26.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.35 / $23.36 / $58.86	Professional	TC	$11.35	$23.36	$58.86
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $29.00 / $29.00 / $29.00	Professional		$29.00	$29.00	$29.00
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $9.78 / $9.78 / $9.78	Professional	26	$9.78	$9.78	$9.78
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $19.22 / $19.22 / $19.22	Professional	TC	$19.22	$19.22	$19.22