Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.45 / $13.45 / $14.12	Facility	26	$13.45	$13.45	$14.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.16 / $11.90 / $29.64	Professional	26	$9.16	$11.90	$29.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.02 / $18.88 / $61.73	Professional	TC	$15.02	$18.88	$61.73
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $44.82 / $57.75 / $110.49	Facility	26	$44.82	$57.75	$110.49
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.32 / $68.50 / $201.83	Professional	26	$36.32	$68.50	$201.83
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $53.73 / $101.57 / $315.60	Professional	TC	$53.73	$101.57	$315.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.00 / $46.02 / $80.65	Professional	26	$27.00	$46.02	$80.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.04 / $69.06 / $127.63	Professional	TC	$41.04	$69.06	$127.63
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $23.68 / $33.18 / $60.75	Facility	26	$23.68	$33.18	$60.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.15 / $34.78 / $60.90	Professional	26	$23.15	$34.78	$60.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.84 / $53.76 / $96.04	Professional	TC	$35.84	$53.76	$96.04
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $40.13 / $48.25 / $48.91	Facility	26	$40.13	$48.25	$48.91
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.10 / $40.13 / $48.91	Professional	26	$32.10	$40.13	$48.91
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $58.84 / $70.45 / $72.36	Professional	TC	$58.84	$70.45	$72.36
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $33.36 / $33.36 / $33.36	Facility	26	$33.36	$33.36	$33.36
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.34 / $46.57 / $69.50	Professional	26	$34.34	$46.57	$69.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.80 / $68.90 / $102.82	Professional	TC	$50.80	$68.90	$102.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $40.29 / $47.99 / $64.64	Professional	26	$40.29	$47.99	$64.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $59.63 / $71.00 / $95.63	Professional	TC	$59.63	$71.00	$95.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.61 / $30.86 / $39.45	Professional	26	$23.61	$30.86	$39.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.61 / $47.09 / $58.36	Professional	TC	$34.61	$47.09	$58.36
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $20.14 / $25.59 / $25.59	Professional	26	$20.14	$25.59	$25.59
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $28.00 / $42.11 / $42.11	Professional	TC	$28.00	$42.11	$42.11