Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $62.54 / $193.45 / $347.52	Facility		$62.54	$193.45	$347.52
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.68 / $37.07 / $60.27	Facility	26	$27.68	$37.07	$60.27
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.36 / $189.64 / $347.52	Facility	TC	$29.36	$189.64	$347.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.18 / $75.00 / $146.57	Professional		$40.18	$75.00	$146.57
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.52 / $26.96 / $60.78	Professional	26	$19.52	$26.96	$60.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $234.74 / $234.74 / $281.35	Professional	50	$234.74	$234.74	$281.35
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.47 / $27.00 / $47.73	Professional	52	$17.47	$27.00	$47.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.73 / $51.48 / $104.25	Professional	TC	$16.73	$51.48	$104.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $44.97 / $49.17 / $49.17	Professional		$44.97	$49.17	$49.17
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $92.00 / $284.82 / $489.19	Facility		$92.00	$284.82	$489.19
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 / $141.03 / $141.03	Facility	TC	$100.00	$141.03	$141.03
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $50.36 / $85.91 / $402.37	Professional		$50.36	$85.91	$402.37
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.34 / $47.73 / $168.68	Professional	26	$27.34	$47.73	$168.68
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $46.88 / $52.09 / $106.50	Professional	50	$46.88	$52.09	$106.50
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.18 / $41.63 / $284.52	Professional	TC	$22.18	$41.63	$284.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.24 / $88.11 / $136.79	Professional		$50.24	$88.11	$136.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.09 / $38.97 / $62.27	Professional	26	$22.09	$38.97	$62.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.54 / $47.85 / $95.05	Professional	TC	$22.54	$47.85	$95.05
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $69.17 / $115.16 / $274.37	Facility		$69.17	$115.16	$274.37
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $21.39 / $46.99 / $315.92	Facility	26	$21.39	$46.99	$315.92
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $37.89 / $74.73 / $315.92	Facility	TC	$37.89	$74.73	$315.92
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $60.38 / $108.04 / $161.40	Professional		$60.38	$108.04	$161.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.39 / $45.56 / $56.84	Professional	26	$21.39	$45.56	$56.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $37.18 / $64.34 / $109.69	Professional	TC	$37.18	$64.34	$109.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.20 / $54.50 / $92.81	Professional		$9.20	$54.50	$92.81
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $60.48 / $74.37 / $145.41	Facility		$60.48	$74.37	$145.41
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.54 / $40.44 / $41.54	Facility	26	$33.54	$40.44	$41.54
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $26.94 / $33.50 / $83.08	Facility	TC	$26.94	$33.50	$83.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $27.34 / $37.20 / $45.56	Professional	26	$27.34	$37.20	$45.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.53 / $71.70 / $95.15	Professional	TC	$26.53	$71.70	$95.15
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $49.38 / $49.38 / $50.73	Facility		$49.38	$49.38	$50.73
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $27.63 / $27.63 / $27.88	Facility	26	$27.63	$27.63	$27.88
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $21.74 / $21.74 / $22.85	Facility	TC	$21.74	$21.74	$22.85
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.22 / $87.40 / $108.46	Professional		$57.22	$87.40	$108.46
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.50 / $47.88 / $58.07	Professional	26	$30.50	$47.88	$58.07
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.26 / $38.69 / $49.61	Professional	TC	$25.26	$38.69	$49.61
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $234.74 / $361.80 / $692.47	Facility		$234.74	$361.80	$692.47
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $217.18 / $217.18 / $354.01	Facility	26	$217.18	$217.18	$354.01
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $217.18 / $217.18 / $354.01	Facility	TC	$217.18	$217.18	$354.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $50.36 / $72.97 / $113.94	Professional		$50.36	$72.97	$113.94
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $40.10 / $54.02	Professional	26	$28.18	$40.10	$54.02
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $22.18 / $32.52 / $52.45	Professional	TC	$22.18	$32.52	$52.45
United Facility/Professional Professional Modifier Low / Median / High Price $48.40 / $90.50 / $125.08	Professional		$48.40	$90.50	$125.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.46 / $36.90 / $60.27	Professional	26	$23.46	$36.90	$60.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.08 / $42.92 / $68.52	Professional	TC	$25.08	$42.92	$68.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $40.88 / $40.88 / $40.88	Professional		$40.88	$40.88	$40.88
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $21.66 / $21.66 / $21.66	Professional	26	$21.66	$21.66	$21.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $19.22 / $19.22 / $19.22	Professional	TC	$19.22	$19.22	$19.22