Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.47 / $257.45 / $529.74	Facility		$37.47	$257.45	$529.74
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.15 / $10.06 / $19.62	Facility	26	$9.15	$10.06	$19.62
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.32 / $78.91 / $668.80	Facility	TC	$28.32	$78.91	$668.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.92 / $38.24 / $102.98	Professional		$24.92	$38.24	$102.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $9.97 / $35.00	Professional	26	$7.03	$9.97	$35.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $47.52 / $73.37 / $96.04	Professional	50	$47.52	$73.37	$96.04
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.20 / $18.73 / $47.56	Professional	52	$11.20	$18.73	$47.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $28.32 / $56.64	Professional	TC	$17.89	$28.32	$56.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $14.83 / $58.53 / $82.58	Professional		$14.83	$58.53	$82.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.66 / $13.30 / $14.64	Professional	26	$7.66	$13.30	$14.64
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $37.03 / $37.03 / $37.03	Professional	50	$37.03	$37.03	$37.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.89 / $50.89 / $50.89	Professional	TC	$50.89	$50.89	$50.89
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $87.86 / $341.91 / $434.49	Facility		$87.86	$341.91	$434.49
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 / $105.96 / $105.96	Facility	TC	$100.00	$105.96	$105.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $42.97 / $74.56 / $274.95	Professional		$42.97	$74.56	$274.95
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.09 / $19.42 / $67.05	Professional	26	$11.09	$19.42	$67.05
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $41.09 / $62.83 / $100.12	Professional	50	$41.09	$62.83	$100.12
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $4.61 / $19.42 / $19.42	Professional	52	$4.61	$19.42	$19.42
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.88 / $55.14 / $207.90	Professional	TC	$31.88	$55.14	$207.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $234.44 / $373.15 / $498.80	Facility		$234.44	$373.15	$498.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.06 / $52.11 / $102.71	Professional		$28.06	$52.11	$102.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.35 / $14.52 / $24.35	Professional	26	$8.35	$14.52	$24.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.43 / $37.33 / $77.59	Professional	TC	$20.43	$37.33	$77.59
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $30.01 / $62.61 / $164.40	Facility		$30.01	$62.61	$164.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $8.97 / $17.57 / $290.81	Facility	26	$8.97	$17.57	$290.81
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $20.63 / $40.33 / $290.81	Facility	TC	$20.63	$40.33	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $27.84 / $56.33 / $83.38	Professional		$27.84	$56.33	$83.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.25 / $16.97 / $22.29	Professional	26	$8.25	$16.97	$22.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.02 / $40.11 / $62.42	Professional	TC	$20.02	$40.11	$62.42
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 $37.72 / $56.95 / $63.65	Facility		$37.72	$56.95	$63.65
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $11.76 / $15.78 / $16.07	Facility	26	$11.76	$15.78	$16.07
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $28.50 / $40.86 / $47.57	Facility	TC	$28.50	$40.86	$47.57
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.65 / $13.92 / $17.76	Professional	26	$9.65	$13.92	$17.76
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $24.12 / $31.90 / $42.92	Professional	TC	$24.12	$31.90	$42.92
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $42.13 / $42.13 / $43.42	Facility		$42.13	$42.13	$43.42
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 $31.26 / $31.26 / $32.45	Facility	TC	$31.26	$31.26	$32.45
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.24 / $72.42 / $89.04	Professional		$46.24	$72.42	$89.04
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.37 / $18.57 / $22.84	Professional	26	$12.37	$18.57	$22.84
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $34.43 / $53.26 / $66.55	Professional	TC	$34.43	$53.26	$66.55
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $202.73 / $304.02 / $592.49	Facility		$202.73	$304.02	$592.49
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	TC	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $42.97 / $64.90 / $85.33	Professional		$42.97	$64.90	$85.33
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 $31.88 / $48.16 / $64.98	Professional	TC	$31.88	$48.16	$64.98
United Facility/Professional Professional Modifier Low / Median / High Price $28.30 / $35.04 / $84.01	Professional		$28.30	$35.04	$84.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $9.52 / $22.79	Professional	26	$8.13	$9.52	$22.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.41 / $25.61 / $60.63	Professional	TC	$20.41	$25.61	$60.63
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $35.94 / $35.94 / $35.94	Professional		$35.94	$35.94	$35.94
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 $27.51 / $27.51 / $27.51	Professional	TC	$27.51	$27.51	$27.51