Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $74.16 / $259.91 / $512.33	Facility		$74.16	$259.91	$512.33
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.21 / $14.68 / $30.06	Facility	26	$12.21	$14.68	$30.06
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $44.05 / $214.99 / $474.68	Facility	TC	$44.05	$214.99	$474.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.60 / $55.26 / $142.19	Professional		$30.60	$55.26	$142.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $13.88 / $34.20	Professional	26	$10.02	$13.88	$34.20
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $46.08 / $46.08 / $102.86	Professional	50	$46.08	$46.08	$102.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $44.05 / $80.73	Professional	TC	$27.55	$44.05	$80.73
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $65.92 / $90.63 / $109.86	Professional		$65.92	$90.63	$109.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.15 / $17.23 / $20.90	Professional	26	$10.15	$17.23	$20.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $46.41 / $59.62 / $80.81	Professional	TC	$46.41	$59.62	$80.81
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $97.17 / $267.44 / $342.77	Facility		$97.17	$267.44	$342.77
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $70.00 / $70.00	Facility	26	$50.00	$70.00	$70.00
Asuris Northwest Health Facility/Professional Facility Modifier TC Low / Median / High Price $74.62 / $168.01 / $168.01	Facility	TC	$74.62	$168.01	$168.01
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $64.09 / $110.68 / $413.18	Professional		$64.09	$110.68	$413.18
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.78 / $25.90 / $88.80	Professional	26	$14.78	$25.90	$88.80
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $65.77 / $70.88 / $96.15	Professional	50	$65.77	$70.88	$96.15
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.90 / $81.68 / $324.38	Professional	TC	$49.90	$81.68	$324.38
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 $42.67 / $76.31 / $155.28	Professional		$42.67	$76.31	$155.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.47 / $19.61 / $32.52	Professional	26	$11.47	$19.61	$32.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.42 / $58.36 / $123.48	Professional	TC	$32.42	$58.36	$123.48
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $47.56 / $83.09 / $221.92	Facility		$47.56	$83.09	$221.92
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.12 / $24.26 / $236.39	Facility	26	$13.12	$24.26	$236.39
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $31.66 / $65.81 / $236.39	Facility	TC	$31.66	$65.81	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.98 / $85.55 / $123.48	Professional		$40.98	$85.55	$123.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.78 / $23.68 / $30.01	Professional	26	$11.78	$23.68	$30.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.35 / $63.64 / $96.77	Professional	TC	$30.35	$63.64	$96.77
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 $57.00 / $87.75 / $95.81	Facility		$57.00	$87.75	$95.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.59 / $21.12 / $21.44	Facility	26	$17.59	$21.12	$21.44
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $48.45 / $67.23 / $74.37	Facility	TC	$48.45	$67.23	$74.37
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.86 / $17.59 / $21.44	Professional	26	$12.86	$17.59	$21.44
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $39.07 / $61.04 / $74.37	Professional	TC	$39.07	$61.04	$74.37
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $63.42 / $63.42 / $65.34	Facility		$63.42	$63.42	$65.34
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $14.50 / $14.50 / $14.62	Facility	26	$14.50	$14.50	$14.62
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $48.92 / $48.92 / $50.73	Facility	TC	$48.92	$48.92	$50.73
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.31 / $109.01 / $134.03	Professional		$72.31	$109.01	$134.03
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.50 / $24.77 / $29.99	Professional	26	$16.50	$24.77	$29.99
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $53.62 / $84.62 / $104.04	Professional	TC	$53.62	$84.62	$104.04
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $164.79 / $251.08 / $489.71	Facility		$164.79	$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 $64.68 / $97.71 / $128.44	Professional		$64.68	$97.71	$128.44
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.36 / $22.14 / $29.88	Professional	26	$15.36	$22.14	$29.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $49.90 / $75.37 / $101.70	Professional	TC	$49.90	$75.37	$101.70
United Facility/Professional Professional Modifier Low / Median / High Price $42.77 / $52.56 / $133.94	Professional		$42.77	$52.56	$133.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.46 / $12.78 / $30.39	Professional	26	$11.46	$12.78	$30.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.48 / $40.63 / $99.38	Professional	TC	$30.48	$40.63	$99.38
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $54.93 / $54.93 / $54.93	Professional		$54.93	$54.93	$54.93
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.25 / $11.25 / $11.25	Professional	26	$11.25	$11.25	$11.25
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $43.68 / $43.68 / $43.68	Professional	TC	$43.68	$43.68	$43.68