Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.65 / $285.00 / $561.60	Facility		$104.65	$285.00	$561.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.79 / $44.89 / $93.44	Facility	26	$36.79	$44.89	$93.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.01 / $108.29 / $425.00	Professional		$81.01	$108.29	$425.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.44 / $41.75 / $137.60	Professional	26	$30.44	$41.75	$137.60
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $111.06 / $542.00 / $675.00	Professional	50	$111.06	$542.00	$675.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.56 / $67.84 / $151.41	Professional	TC	$50.56	$67.84	$151.41
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.63 / $157.99 / $191.50	Professional		$66.63	$157.99	$191.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.88 / $51.88 / $63.20	Professional	26	$25.88	$51.88	$63.20
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $99.95 / $265.70 / $349.63	Professional	50	$99.95	$265.70	$349.63
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $58.28 / $58.28 / $58.28	Professional	TC	$58.28	$58.28	$58.28
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $174.46 / $257.51 / $514.16	Facility		$174.46	$257.51	$514.16
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $67.43 / $85.00 / $146.86	Facility	26	$67.43	$85.00	$146.86
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $117.35 / $211.51 / $731.25	Professional		$117.35	$211.51	$731.25
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.35 / $80.20 / $267.23	Professional	26	$44.35	$80.20	$267.23
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $127.78 / $151.94 / $244.96	Professional	50	$127.78	$151.94	$244.96
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $73.00 / $129.74 / $464.10	Professional	TC	$73.00	$129.74	$464.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $127.23 / $297.08 / $396.70	Facility		$127.23	$297.08	$396.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.01 / $157.21 / $273.10	Professional		$95.01	$157.21	$273.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.11 / $59.47 / $98.95	Professional	26	$36.11	$59.47	$98.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $59.47 / $98.32 / $174.09	Professional	TC	$59.47	$98.32	$174.09
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $82.61 / $167.17 / $260.05	Facility		$82.61	$167.17	$260.05
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $68.19 / $114.57	Facility	26	$31.62	$68.19	$114.57
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $86.36 / $175.77 / $232.88	Professional		$86.36	$175.77	$232.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $67.14 / $85.40	Professional	26	$31.62	$67.14	$85.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $55.07 / $108.81 / $148.50	Professional	TC	$55.07	$108.81	$148.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.12 / $100.63 / $227.98	Professional		$21.12	$100.63	$227.98
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $121.61 / $167.29 / $172.72	Facility		$121.61	$167.29	$172.72
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $52.80 / $63.80 / $64.98	Facility	26	$52.80	$63.80	$64.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $42.24 / $54.98 / $65.23	Professional	26	$42.24	$54.98	$65.23
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $75.88 / $90.91 / $106.53	Professional	TC	$75.88	$90.91	$106.53
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $115.06 / $115.06 / $116.54	Facility		$115.06	$115.06	$116.54
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $43.49 / $43.49 / $43.87	Facility	26	$43.49	$43.49	$43.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.97 / $194.79 / $239.01	Professional		$131.97	$194.79	$239.01
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.00 / $73.81 / $89.98	Professional	26	$50.00	$73.81	$89.98
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.96 / $121.21 / $149.03	Professional	TC	$81.96	$121.21	$149.03
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $166.99 / $251.29 / $489.71	Facility		$166.99	$251.29	$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 Professional Modifier Low / Median / High Price $117.35 / $169.50 / $229.04	Professional		$117.35	$169.50	$229.04
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.35 / $64.51 / $86.23	Professional	26	$44.35	$64.51	$86.23
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $73.00 / $105.27 / $141.63	Professional	TC	$73.00	$105.27	$141.63
United Facility/Professional Professional Modifier Low / Median / High Price $86.75 / $97.55 / $233.39	Professional		$86.75	$97.55	$233.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.65 / $38.36 / $88.43	Professional	26	$34.65	$38.36	$88.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.49 / $59.63 / $151.05	Professional	TC	$54.49	$59.63	$151.05
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $95.75 / $95.75 / $95.75	Professional		$95.75	$95.75	$95.75
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.90 / $33.90 / $33.90	Professional	26	$33.90	$33.90	$33.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $61.84 / $61.84 / $61.84	Professional	TC	$61.84	$61.84	$61.84