Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $134.90 / $229.09 / $275.42	Facility	26	$134.90	$229.09	$275.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $416.87 / $891.25	Professional		$323.59	$416.87	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $123.03 / $263.03	Professional	26	$100.00	$123.03	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $288.40 / $602.56	Professional	TC	$218.78	$288.40	$602.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $724.44 / $1,148.15	Professional		$398.11	$724.44	$1,148.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $208.93 / $309.03	Professional	26	$134.90	$208.93	$309.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $512.86 / $812.83	Professional	TC	$263.03	$512.86	$812.83
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $131.83 / $229.09 / $2,754.23	Facility	26	$131.83	$229.09	$2,754.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $660.69 / $933.25	Professional		$371.54	$660.69	$933.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $223.87 / $269.15	Professional	26	$131.83	$223.87	$269.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $512.86 / $707.95	Professional	TC	$269.15	$512.86	$707.95
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $75.86	Professional		$32.36	$33.11	$75.86
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $173.78 / $204.17 / $208.93	Facility	26	$173.78	$204.17	$208.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $186.21 / $234.42	Professional	26	$125.89	$186.21	$234.42
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $338.84 / $512.86	Professional	TC	$263.03	$338.84	$512.86
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $138.04 / $144.54	Facility	26	$138.04	$138.04	$144.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $831.76 / $1,000.00	Professional		$501.19	$831.76	$1,000.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $234.42 / $302.00	Professional	26	$144.54	$234.42	$302.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $588.84 / $691.83	Professional	TC	$354.81	$588.84	$691.83
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,122.02 / $1,122.02 / $1,122.02	Facility	26	$1,122.02	$1,122.02	$1,122.02
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $691.83 / $933.25	Professional		$467.74	$691.83	$933.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $199.53 / $269.15	Professional	26	$141.25	$199.53	$269.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $489.78 / $676.08	Professional	TC	$338.84	$489.78	$676.08
United Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $524.81 / $1,023.29	Professional		$331.13	$524.81	$1,023.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $169.82 / $302.00	Professional	26	$107.15	$169.82	$302.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $354.81 / $724.44	Professional	TC	$223.87	$354.81	$724.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $467.74 / $645.65	Professional		$346.74	$467.74	$645.65
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $144.54 / $204.17	Professional	26	$107.15	$144.54	$204.17
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $316.23 / $446.68	Professional	TC	$234.42	$316.23	$446.68