Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $39.03 / $225.72 / $454.52	Facility		$39.03	$225.72	$454.52
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.73 / $11.50 / $23.12	Facility	26	$8.73	$11.50	$23.12
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.17 / $170.48 / $473.34	Facility	TC	$29.17	$170.48	$473.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.60 / $38.14 / $99.00	Professional		$21.60	$38.14	$99.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $10.63 / $34.85	Professional	26	$7.33	$10.63	$34.85
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $55.28 / $112.62 / $259.50	Professional	50	$55.28	$112.62	$259.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $29.17 / $55.43	Professional	TC	$17.57	$29.17	$55.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $24.94 / $59.15 / $83.49	Professional		$24.94	$59.15	$83.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.80 / $12.36 / $13.86	Professional	26	$7.80	$12.36	$13.86
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $44.66 / $44.66 / $52.34	Professional	TC	$44.66	$44.66	$52.34
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $95.36 / $277.93 / $972.00	Facility		$95.36	$277.93	$972.00
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 / $109.00 / $109.00	Facility	TC	$100.00	$109.00	$109.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $43.42 / $75.36 / $274.95	Professional		$43.42	$75.36	$274.95
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.63 / $19.27 / $75.00	Professional	26	$10.63	$19.27	$75.00
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $41.53 / $63.49 / $101.20	Professional	50	$41.53	$63.49	$101.20
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.79 / $56.71 / $210.83	Professional	TC	$32.79	$56.71	$210.83
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 $28.73 / $52.59 / $102.71	Professional		$28.73	$52.59	$102.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.35 / $14.49 / $23.30	Professional	26	$8.35	$14.49	$23.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.99 / $38.21 / $79.98	Professional	TC	$20.99	$38.21	$79.98
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $30.35 / $61.98 / $164.40	Facility		$30.35	$61.98	$164.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $7.75 / $17.45 / $236.39	Facility	26	$7.75	$17.45	$236.39
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $20.14 / $40.84 / $236.39	Facility	TC	$20.14	$40.84	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $28.16 / $56.49 / $84.13	Professional		$28.16	$56.49	$84.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.75 / $17.43 / $21.43	Professional	26	$7.75	$17.43	$21.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.14 / $39.47 / $64.64	Professional	TC	$20.14	$39.47	$64.64
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 $39.24 / $56.44 / $63.65	Facility		$39.24	$56.44	$63.65
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $12.64 / $15.11 / $16.07	Facility	26	$12.64	$15.11	$16.07
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $32.49 / $42.21 / $48.24	Facility	TC	$32.49	$42.21	$48.24
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.35 / $14.50 / $17.52	Professional	26	$10.35	$14.50	$17.52
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.33 / $34.36 / $42.75	Professional	TC	$25.33	$34.36	$42.75
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $42.58 / $42.58 / $43.42	Facility		$42.58	$42.58	$43.42
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $10.42 / $10.42 / $10.51	Facility	26	$10.42	$10.42	$10.51
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $32.15 / $32.15 / $32.90	Facility	TC	$32.15	$32.15	$32.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.04 / $72.42 / $89.04	Professional		$48.04	$72.42	$89.04
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.87 / $18.05 / $21.56	Professional	26	$11.87	$18.05	$21.56
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.40 / $54.89 / $67.48	Professional	TC	$36.40	$54.89	$67.48
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 $44.38 / $65.08 / $85.33	Professional		$44.38	$65.08	$85.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.04 / $15.92 / $22.07	Professional	26	$11.04	$15.92	$22.07
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $32.79 / $49.32 / $66.86	Professional	TC	$32.79	$49.32	$66.86
United Facility/Professional Professional Modifier Low / Median / High Price $28.58 / $36.52 / $86.60	Professional		$28.58	$36.52	$86.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.30 / $9.60 / $21.84	Professional	26	$8.30	$9.60	$21.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.07 / $25.01 / $62.37	Professional	TC	$20.07	$25.01	$62.37
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $36.34 / $36.34 / $36.34	Professional		$36.34	$36.34	$36.34
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.03 / $8.03 / $8.03	Professional	26	$8.03	$8.03	$8.03
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $28.29 / $28.29 / $28.29	Professional	TC	$28.29	$28.29	$28.29