Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.84 / $210.30 / $462.08	Facility		$40.84	$210.30	$462.08
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.51 / $11.58 / $24.09	Facility	26	$9.51	$11.58	$24.09
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.17 / $170.48 / $455.69	Facility	TC	$29.17	$170.48	$455.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.40 / $45.57 / $130.19	Professional		$23.40	$45.57	$130.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $11.06 / $33.35	Professional	26	$7.33	$11.06	$33.35
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $79.14 / $79.14 / $119.13	Professional	50	$79.14	$79.14	$119.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.51 / $33.29 / $61.76	Professional	TC	$23.51	$33.29	$61.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.72 / $60.37 / $69.30	Professional		$25.72	$60.37	$69.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.66 / $13.45 / $15.08	Professional	26	$6.66	$13.45	$15.08
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $48.96 / $53.08 / $53.08	Professional	TC	$48.96	$53.08	$53.08
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $277.93 / $342.77	Facility		$109.65	$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 / $110.49 / $110.49	Facility	TC	$100.00	$110.49	$110.49
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $44.81 / $77.73 / $286.35	Professional		$44.81	$77.73	$286.35
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.55 / $19.64 / $74.30	Professional	26	$11.55	$19.64	$74.30
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $42.79 / $65.54 / $110.10	Professional	50	$42.79	$65.54	$110.10
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.26 / $57.91 / $216.60	Professional	TC	$33.26	$57.91	$216.60
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 $33.40 / $59.20 / $107.01	Professional		$33.40	$59.20	$107.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.69 / $15.12 / $25.36	Professional	26	$8.69	$15.12	$25.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.23 / $43.99 / $82.21	Professional	TC	$24.23	$43.99	$82.21
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $36.04 / $74.47 / $164.40	Facility		$36.04	$74.47	$164.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $18.95 / $236.39	Facility	26	$9.77	$18.95	$236.39
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $24.18 / $51.32 / $236.39	Facility	TC	$24.18	$51.32	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $31.93 / $67.77 / $89.67	Professional		$31.93	$67.77	$89.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.00 / $18.19 / $23.15	Professional	26	$9.00	$18.19	$23.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $24.18 / $49.74 / $66.70	Professional	TC	$24.18	$49.74	$66.70
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 $43.15 / $60.07 / $66.33	Facility		$43.15	$60.07	$66.33
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $12.25 / $16.45 / $16.75	Facility	26	$12.25	$16.45	$16.75
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $35.90 / $44.11 / $49.58	Facility	TC	$35.90	$44.11	$49.58
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.05 / $14.75 / $18.50	Professional	26	$10.05	$14.75	$18.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $27.34 / $40.47 / $50.06	Professional	TC	$27.34	$40.47	$50.06
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $43.94 / $43.94 / $45.24	Facility		$43.94	$43.94	$45.24
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $11.33 / $11.33 / $11.43	Facility	26	$11.33	$11.33	$11.43
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $32.61 / $32.61 / $33.82	Facility	TC	$32.61	$32.61	$33.82
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.52 / $75.47 / $92.79	Professional		$50.52	$75.47	$92.79
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.89 / $19.05 / $23.43	Professional	26	$12.89	$19.05	$23.43
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $37.63 / $56.41 / $69.36	Professional	TC	$37.63	$56.41	$69.36
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 $46.64 / $67.70 / $88.92	Professional		$46.64	$67.70	$88.92
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.00 / $17.20 / $23.35	Professional	26	$12.00	$17.20	$23.35
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.26 / $50.25 / $67.80	Professional	TC	$33.26	$50.25	$67.80
United Facility/Professional Professional Modifier Low / Median / High Price $31.40 / $37.10 / $85.98	Professional		$31.40	$37.10	$85.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.66 / $9.92 / $23.90	Professional	26	$8.66	$9.92	$23.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.38 / $27.21 / $66.56	Professional	TC	$22.38	$27.21	$66.56
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $37.46 / $37.46 / $37.46	Professional		$37.46	$37.46	$37.46
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.77 / $8.77 / $8.77	Professional	26	$8.77	$8.77	$8.77
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $28.69 / $28.69 / $28.69	Professional	TC	$28.69	$28.69	$28.69