Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $56.53 / $253.36 / $598.42	Facility		$56.53	$253.36	$598.42
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.51 / $12.00 / $30.30	Facility	26	$9.51	$12.00	$30.30
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $39.36 / $241.36 / $587.10	Facility	TC	$39.36	$241.36	$587.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.59 / $51.72 / $146.00	Professional		$25.59	$51.72	$146.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.63 / $11.59 / $38.00	Professional	26	$7.63	$11.59	$38.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.85 / $183.49 / $299.48	Professional	50	$17.85	$183.49	$299.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.37 / $39.36 / $78.73	Professional	TC	$25.37	$39.36	$78.73
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $65.06 / $76.55 / $107.27	Professional		$65.06	$76.55	$107.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.77 / $13.45 / $16.30	Professional	26	$8.77	$13.45	$16.30
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $52.25 / $53.17 / $72.06	Professional	TC	$52.25	$53.17	$72.06
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $102.16 / $277.93 / $342.77	Facility		$102.16	$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 / $149.85 / $149.85	Facility	TC	$100.00	$149.85	$149.85
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $51.86 / $97.56 / $359.10	Professional		$51.86	$97.56	$359.10
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.55 / $20.23 / $69.68	Professional	26	$11.55	$20.23	$69.68
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $53.83 / $77.09 / $127.20	Professional	50	$53.83	$77.09	$127.20
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.31 / $76.03 / $289.43	Professional	TC	$43.31	$76.03	$289.43
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 $35.69 / $67.11 / $134.90	Professional		$35.69	$67.11	$134.90
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 $27.30 / $52.05 / $109.27	Professional	TC	$27.30	$52.05	$109.27
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $37.52 / $80.42 / $164.40	Facility		$37.52	$80.42	$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 $28.21 / $57.39 / $236.39	Facility	TC	$28.21	$57.39	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.96 / $71.15 / $109.91	Professional		$35.96	$71.15	$109.91
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 $28.14 / $52.81 / $89.44	Professional	TC	$28.14	$52.81	$89.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.29 / $54.21 / $92.49	Professional		$9.29	$54.21	$92.49
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $51.00 / $73.03 / $83.08	Facility		$51.00	$73.03	$83.08
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $12.74 / $16.45 / $16.75	Facility	26	$12.74	$16.45	$16.75
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $40.18 / $56.28 / $66.33	Facility	TC	$40.18	$56.28	$66.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.05 / $15.00 / $18.32	Professional	26	$10.05	$15.00	$18.32
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.36 / $48.00 / $64.05	Professional	TC	$33.36	$48.00	$64.05
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $55.27 / $55.27 / $56.67	Facility		$55.27	$55.27	$56.67
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 $43.94 / $43.94 / $45.24	Facility	TC	$43.94	$43.94	$45.24
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.71 / $94.53 / $116.23	Professional		$62.71	$94.53	$116.23
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 $48.21 / $75.47 / $92.79	Professional	TC	$48.21	$75.47	$92.79
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 $56.36 / $84.94 / $111.38	Professional		$56.36	$84.94	$111.38
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 $44.81 / $67.70 / $91.34	Professional	TC	$44.81	$67.70	$91.34
United Facility/Professional Professional Modifier Low / Median / High Price $35.84 / $43.60 / $107.73	Professional		$35.84	$43.60	$107.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.66 / $9.92 / $24.70	Professional	26	$8.66	$9.92	$24.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.67 / $35.06 / $84.89	Professional	TC	$26.67	$35.06	$84.89
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $47.72 / $47.72 / $47.72	Professional		$47.72	$47.72	$47.72
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 $38.95 / $38.95 / $38.95	Professional	TC	$38.95	$38.95	$38.95