Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $35.26 / $220.58 / $430.72	Facility		$35.26	$220.58	$430.72
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.15 / $11.73 / $22.17	Facility	26	$9.15	$11.73	$22.17
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.76 / $123.77 / $339.22	Facility	TC	$25.76	$123.77	$339.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.50 / $37.76 / $83.70	Professional		$22.50	$37.76	$83.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.74 / $9.48 / $26.11	Professional	26	$6.74	$9.48	$26.11
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $132.12 / $132.12 / $134.66	Professional	50	$132.12	$132.12	$134.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.82 / $25.77 / $50.24	Professional	TC	$18.82	$25.77	$50.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.13 / $62.10 / $77.09	Professional		$23.13	$62.10	$77.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.41 / $12.92 / $13.93	Professional	26	$6.41	$12.92	$13.93
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $88.21 / $277.93 / $342.77	Facility		$88.21	$277.93	$342.77
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Asuris Northwest Health Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	TC	$100.00	$100.00	$100.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $40.19 / $70.28 / $254.55	Professional		$40.19	$70.28	$254.55
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.09 / $18.48 / $67.70	Professional	26	$11.09	$18.48	$67.70
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $38.43 / $58.87 / $95.33	Professional	50	$38.43	$58.87	$95.33
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.11 / $50.43 / $187.50	Professional	TC	$29.11	$50.43	$187.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $127.23 / $297.08 / $374.65	Facility		$127.23	$297.08	$374.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.07 / $51.40 / $94.90	Professional		$27.07	$51.40	$94.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.00 / $14.07 / $24.35	Professional	26	$8.00	$14.07	$24.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.73 / $36.06 / $71.06	Professional	TC	$19.73	$36.06	$71.06
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $28.89 / $59.08 / $164.40	Facility		$28.89	$59.08	$164.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $8.56 / $16.78 / $236.39	Facility	26	$8.56	$16.78	$236.39
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $20.14 / $41.15 / $236.39	Facility	TC	$20.14	$41.15	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $27.28 / $54.79 / $78.06	Professional		$27.28	$54.79	$78.06
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.87 / $16.19 / $21.52	Professional	26	$7.87	$16.19	$21.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.14 / $39.97 / $58.36	Professional	TC	$20.14	$39.97	$58.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.15 / $54.50 / $92.81	Professional		$9.15	$54.50	$92.81
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $37.31 / $53.60 / $58.96	Facility		$37.31	$53.60	$58.96
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.11 / $15.41 / $16.07	Facility	26	$13.11	$15.41	$16.07
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $30.78 / $38.64 / $42.88	Facility	TC	$30.78	$38.64	$42.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.66 / $13.44 / $16.79	Professional	26	$9.66	$13.44	$16.79
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $23.32 / $34.77 / $42.66	Professional	TC	$23.32	$34.77	$42.66
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $39.40 / $39.40 / $40.22	Facility		$39.40	$39.40	$40.22
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $10.87 / $10.87 / $10.97	Facility	26	$10.87	$10.87	$10.97
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $28.54 / $28.54 / $29.25	Facility	TC	$28.54	$28.54	$29.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.50 / $67.08 / $82.48	Professional		$44.50	$67.08	$82.48
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.33 / $18.57 / $22.50	Professional	26	$12.33	$18.57	$22.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $48.79 / $59.99	Professional	TC	$32.36	$48.79	$59.99
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $156.94 / $251.08 / $489.71	Facility		$156.94	$251.08	$489.71
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $156.94 / $156.94 / $209.36	Facility	26	$156.94	$156.94	$209.36
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $156.94 / $156.94 / $209.36	Facility	TC	$156.94	$156.94	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $41.11 / $60.28 / $79.04	Professional		$41.11	$60.28	$79.04
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.52 / $16.52 / $22.41	Professional	26	$11.52	$16.52	$22.41
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $29.11 / $43.84 / $59.33	Professional	TC	$29.11	$43.84	$59.33
United Facility/Professional Facility Modifier Low / Median / High Price $5.43 / $14.49 / $19.92	Facility		$5.43	$14.49	$19.92
United Facility/Professional Professional Modifier Low / Median / High Price $27.21 / $32.79 / $79.05	Professional		$27.21	$32.79	$79.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.93 / $9.59 / $22.48	Professional	26	$7.93	$9.59	$22.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.76 / $23.86 / $60.81	Professional	TC	$19.76	$23.86	$60.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $33.57 / $33.57 / $33.57	Professional		$33.57	$33.57	$33.57
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.44 / $8.44 / $8.44	Professional	26	$8.44	$8.44	$8.44
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $25.14 / $25.14 / $25.14	Professional	TC	$25.14	$25.14	$25.14