Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.73 / $208.00 / $552.09	Facility		$43.73	$208.00	$552.09
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.89 / $12.05 / $25.37	Facility	26	$9.89	$12.05	$25.37
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.57 / $96.19 / $513.07	Facility	TC	$32.57	$96.19	$513.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.15 / $42.46 / $118.75	Professional		$27.15	$42.46	$118.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.21 / $11.74 / $39.20	Professional	26	$8.21	$11.74	$39.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.96 / $32.57 / $61.61	Professional	TC	$20.96	$32.57	$61.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.04 / $66.67 / $93.53	Professional		$28.04	$66.67	$93.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.78 / $13.99 / $15.03	Professional	26	$6.78	$13.99	$15.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.96 / $50.96 / $50.96	Professional	TC	$50.96	$50.96	$50.96
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $72.64 / $267.44 / $342.77	Facility		$72.64	$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 $54.36 / $122.62 / $122.62	Facility	TC	$54.36	$122.62	$122.62
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $48.51 / $83.15 / $309.38	Professional		$48.51	$83.15	$309.38
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.01 / $21.04 / $72.38	Professional	26	$12.01	$21.04	$72.38
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $49.51 / $71.52 / $112.38	Professional	50	$49.51	$71.52	$112.38
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.50 / $60.83 / $237.00	Professional	TC	$36.50	$60.83	$237.00
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 $32.63 / $59.26 / $115.77	Professional		$32.63	$59.26	$115.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.44 / $16.36 / $26.37	Professional	26	$9.44	$16.36	$26.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.66 / $43.00 / $90.02	Professional	TC	$23.66	$43.00	$90.02
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $37.31 / $74.90 / $221.92	Facility		$37.31	$74.90	$221.92
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $10.92 / $19.98 / $236.39	Facility	26	$10.92	$19.98	$236.39
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $24.66 / $49.58 / $236.39	Facility	TC	$24.66	$49.58	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $32.54 / $67.30 / $93.46	Professional		$32.54	$67.30	$93.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.94 / $19.67 / $24.01	Professional	26	$9.94	$19.67	$24.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.46 / $48.52 / $72.08	Professional	TC	$23.46	$48.52	$72.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.15 / $54.73 / $92.91	Professional		$9.15	$54.73	$92.91
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $44.59 / $65.61 / $71.69	Facility		$44.59	$65.61	$71.69
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.29 / $17.12 / $18.09	Facility	26	$14.29	$17.12	$18.09
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $37.04 / $48.98 / $54.27	Facility	TC	$37.04	$48.98	$54.27
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.80 / $14.30 / $18.63	Professional	26	$10.80	$14.30	$18.63
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.55 / $44.55 / $54.27	Professional	TC	$30.55	$44.55	$54.27
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $47.57 / $47.57 / $48.90	Facility		$47.57	$47.57	$48.90
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $11.78 / $11.78 / $11.88	Facility	26	$11.78	$11.78	$11.88
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $35.79 / $35.79 / $37.02	Facility	TC	$35.79	$35.79	$37.02
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.11 / $81.56 / $100.29	Professional		$54.11	$81.56	$100.29
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.40 / $20.12 / $24.37	Professional	26	$13.40	$20.12	$24.37
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.86 / $61.75 / $75.92	Professional	TC	$39.86	$61.75	$75.92
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 $49.99 / $73.28 / $96.11	Professional		$49.99	$73.28	$96.11
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.48 / $17.98 / $24.83	Professional	26	$12.48	$17.98	$24.83
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $36.50 / $55.13 / $74.39	Professional	TC	$36.50	$55.13	$74.39
United Facility/Professional Professional Modifier Low / Median / High Price $32.82 / $39.89 / $95.87	Professional		$32.82	$39.89	$95.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.38 / $11.02 / $24.70	Professional	26	$9.38	$11.02	$24.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.28 / $30.20 / $76.95	Professional	TC	$23.28	$30.20	$76.95
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $40.96 / $40.96 / $40.96	Professional		$40.96	$40.96	$40.96
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $9.11 / $9.11 / $9.11	Professional	26	$9.11	$9.11	$9.11
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $31.85 / $31.85 / $31.85	Professional	TC	$31.85	$31.85	$31.85