Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $88.80 / $165.58 / $511.19	Facility		$88.80	$165.58	$511.19
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.18 / $73.76 / $107.59	Facility	26	$47.18	$73.76	$107.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.04 / $124.46 / $307.48	Professional		$60.04	$124.46	$307.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.88 / $66.84 / $106.42	Professional	26	$34.88	$66.84	$106.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.84 / $59.59 / $184.25	Professional	TC	$26.84	$59.59	$184.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $49.73 / $49.73 / $49.73	Professional		$49.73	$49.73	$49.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.69 / $51.69 / $51.69	Professional	26	$51.69	$51.69	$51.69
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $21.89 / $22.24 / $22.24	Professional	TC	$21.89	$22.24	$22.24
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $56.07 / $442.67 / $2,922.50	Facility		$56.07	$442.67	$2,922.50
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $49.81 / $323.94 / $323.94	Facility	26	$49.81	$323.94	$323.94
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $81.37 / $150.44 / $1,317.18	Professional		$81.37	$150.44	$1,317.18
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.81 / $84.37 / $638.00	Professional	26	$49.81	$84.37	$638.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.42 / $64.91 / $870.88	Professional	TC	$37.42	$64.91	$870.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $62.82 / $62.82 / $62.82	Facility		$62.82	$62.82	$62.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $80.78 / $143.94 / $300.27	Professional		$80.78	$143.94	$300.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.20 / $75.62 / $122.83	Professional	26	$42.20	$75.62	$122.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.39 / $64.72 / $181.23	Professional	TC	$35.39	$64.72	$181.23
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $62.26 / $168.56 / $471.32	Facility		$62.26	$168.56	$471.32
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $39.90 / $82.65 / $188.55	Facility	26	$39.90	$82.65	$188.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.50 / $139.88 / $424.99	Professional		$58.50	$139.88	$424.99
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.79 / $68.51 / $169.94	Professional	26	$33.79	$68.51	$169.94
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.47 / $69.64 / $270.23	Professional	TC	$28.47	$69.64	$270.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $13.11 / $65.40 / $150.68	Professional		$13.11	$65.40	$150.68
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $99.50 / $126.08 / $356.32	Facility		$99.50	$126.08	$356.32
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $59.88 / $71.33 / $135.56	Facility	26	$59.88	$71.33	$135.56
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $45.41 / $45.41 / $47.37	Professional		$45.41	$45.41	$47.37
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $45.36 / $72.36 / $143.00	Professional	26	$45.36	$72.36	$143.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $37.38 / $59.63 / $210.60	Professional	TC	$37.38	$59.63	$210.60
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $86.07 / $86.07 / $88.20	Facility		$86.07	$86.07	$88.20
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $49.38 / $49.38 / $49.81	Facility	26	$49.38	$49.38	$49.81
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $90.79 / $145.33 / $175.07	Professional		$90.79	$145.33	$175.07
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.62 / $82.94 / $99.27	Professional	26	$51.62	$82.94	$99.27
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.51 / $62.39 / $76.20	Professional	TC	$39.51	$62.39	$76.20
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $287.05 / $442.67 / $846.77	Facility		$287.05	$442.67	$846.77
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $270.73 / $270.73 / $459.43	Facility	26	$270.73	$270.73	$459.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $87.78 / $123.65 / $170.90	Professional		$87.78	$123.65	$170.90
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.36 / $70.56 / $96.52	Professional	26	$50.36	$70.56	$96.52
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $37.42 / $53.14 / $74.88	Professional	TC	$37.42	$53.14	$74.88
United Facility/Professional Facility Modifier Low / Median / High Price $138.83 / $414.00 / $5,793.00	Facility		$138.83	$414.00	$5,793.00
United Facility/Professional Professional Modifier Low / Median / High Price $80.64 / $152.77 / $263.12	Professional		$80.64	$152.77	$263.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.65 / $79.63 / $113.22	Professional	26	$44.65	$79.63	$113.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.43 / $64.73 / $173.44	Professional	TC	$34.43	$64.73	$173.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $53.01 / $63.25 / $70.64	Professional		$53.01	$63.25	$70.64
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.09 / $35.40 / $38.01	Professional	26	$30.09	$35.40	$38.01
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $22.92 / $27.84 / $32.64	Professional	TC	$22.92	$27.84	$32.64