Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.36 / $272.43 / $598.44	Facility		$43.36	$272.43	$598.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.15 / $12.00 / $25.37	Facility	26	$9.15	$12.00	$25.37
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.14 / $170.48 / $546.08	Facility	TC	$32.14	$170.48	$546.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.24 / $41.31 / $108.00	Professional		$22.24	$41.31	$108.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.68 / $11.06 / $37.82	Professional	26	$7.68	$11.06	$37.82
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $52.24 / $120.00 / $252.00	Professional	50	$52.24	$120.00	$252.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.06 / $20.65 / $42.44	Professional	52	$12.06	$20.65	$42.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.46 / $31.86 / $61.76	Professional	TC	$19.46	$31.86	$61.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.22 / $64.52 / $78.20	Professional		$33.22	$64.52	$78.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.41 / $12.92 / $13.93	Professional	26	$6.41	$12.92	$13.93
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $63.00 / $63.00 / $63.00	Professional	50	$63.00	$63.00	$63.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $44.47 / $56.72 / $61.32	Professional	TC	$44.47	$56.72	$61.32
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $95.07 / $277.93 / $342.77	Facility		$95.07	$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 / $118.08 / $118.08	Facility	TC	$100.00	$118.08	$118.08
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $47.12 / $81.70 / $298.27	Professional		$47.12	$81.70	$298.27
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.09 / $19.21 / $67.70	Professional	26	$11.09	$19.21	$67.70
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $45.06 / $68.11 / $108.81	Professional	50	$45.06	$68.11	$108.81
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $4.61 / $4.61 / $4.61	Professional	52	$4.61	$4.61	$4.61
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.04 / $61.79 / $231.23	Professional	TC	$36.04	$61.79	$231.23
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 $30.88 / $57.06 / $111.64	Professional		$30.88	$57.06	$111.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.35 / $14.76 / $24.35	Professional	26	$8.35	$14.76	$24.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.74 / $41.54 / $87.79	Professional	TC	$22.74	$41.54	$87.79
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $30.69 / $66.14 / $164.40	Facility		$30.69	$66.14	$164.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $8.68 / $18.36 / $236.39	Facility	26	$8.68	$18.36	$236.39
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $22.63 / $45.69 / $236.39	Facility	TC	$22.63	$45.69	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $30.39 / $60.39 / $91.71	Professional		$30.39	$60.39	$91.71
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.68 / $18.19 / $22.30	Professional	26	$8.68	$18.19	$22.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $22.63 / $42.75 / $70.59	Professional	TC	$22.63	$42.75	$70.59
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 $42.63 / $62.44 / $69.01	Facility		$42.63	$62.44	$69.01
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.19 / $15.78 / $16.32	Facility	26	$13.19	$15.78	$16.32
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $33.39 / $46.90 / $52.93	Facility	TC	$33.39	$46.90	$52.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.30 / $14.47 / $17.76	Professional	26	$10.30	$14.47	$17.76
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.14 / $35.90 / $47.18	Professional	TC	$28.14	$35.90	$47.18
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $46.21 / $46.21 / $47.07	Facility		$46.21	$46.21	$47.07
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 $35.33 / $35.33 / $36.10	Facility	TC	$35.33	$35.33	$36.10
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.67 / $78.52 / $96.54	Professional		$50.67	$78.52	$96.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.37 / $18.72 / $22.50	Professional	26	$12.37	$18.72	$22.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.86 / $60.22 / $74.05	Professional	TC	$38.86	$60.22	$74.05
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 $48.12 / $70.56 / $92.51	Professional		$48.12	$70.56	$92.51
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.52 / $16.61 / $22.41	Professional	26	$11.52	$16.61	$22.41
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $36.04 / $54.12 / $73.45	Professional	TC	$36.04	$54.12	$73.45
United Facility/Professional Professional Modifier Low / Median / High Price $31.16 / $38.39 / $92.88	Professional		$31.16	$38.39	$92.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.66 / $11.01 / $27.55	Professional	26	$8.66	$11.01	$27.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.51 / $29.45 / $75.05	Professional	TC	$22.51	$29.45	$75.05
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $39.10 / $39.10 / $39.10	Professional		$39.10	$39.10	$39.10
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 $30.66 / $30.66 / $30.66	Professional	TC	$30.66	$30.66	$30.66