Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.84 / $7.84 / $68.59	Facility	26	$7.84	$7.84	$68.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.82 / $7.75 / $37.96	Professional	26	$5.82	$7.75	$37.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.53 / $26.37 / $132.18	Professional	TC	$20.53	$26.37	$132.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.00 / $42.22 / $47.70	Professional	26	$30.00	$42.22	$47.70
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $123.01 / $123.01 / $123.01	Professional	TC	$123.01	$123.01	$123.01
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 $36.02 / $68.50 / $201.83	Professional	26	$36.02	$68.50	$201.83
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $115.42 / $218.20 / $677.78	Professional	TC	$115.42	$218.20	$677.78
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 $88.17 / $148.38 / $274.24	Professional	TC	$88.17	$148.38	$274.24
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 $77.12 / $115.68 / $206.65	Professional	TC	$77.12	$115.68	$206.65
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 / $41.57 / $48.91	Professional	26	$32.10	$41.57	$48.91
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $125.93 / $150.82 / $155.44	Professional	TC	$125.93	$150.82	$155.44
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 $109.13 / $148.02 / $220.86	Professional	TC	$109.13	$148.02	$220.86
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 $128.09 / $152.51 / $205.44	Professional	TC	$128.09	$152.51	$205.44
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 $74.08 / $101.17 / $125.38	Professional	TC	$74.08	$101.17	$125.38
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 $61.00 / $90.13 / $90.13	Professional	TC	$61.00	$90.13	$90.13