Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.39 / $37.15 / $54.95	Facility	26	$22.39	$37.15	$54.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $109.65 / $251.19	Professional		$72.44	$109.65	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $25.70 / $64.57	Professional	26	$16.98	$25.70	$64.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $79.43 / $186.21	Professional	TC	$51.29	$79.43	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $147.91 / $295.12	Professional		$77.62	$147.91	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $32.36 / $58.88	Professional	26	$17.78	$32.36	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $112.20 / $245.47	Professional	TC	$60.26	$112.20	$245.47
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $38.02 / $288.40	Facility	26	$22.91	$38.02	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $154.88 / $257.04	Professional		$85.11	$154.88	$257.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $36.31 / $50.12	Professional	26	$19.95	$36.31	$50.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $123.03 / $208.93	Professional	TC	$66.07	$123.03	$208.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $38.90 / $39.81	Facility	26	$32.36	$38.90	$39.81
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $67.61 / $89.13	Professional		$58.88	$67.61	$89.13
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $32.36 / $40.74	Professional	26	$23.99	$32.36	$40.74
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $128.82 / $154.88	Professional	TC	$81.28	$128.82	$154.88
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $26.92 / $26.92	Facility	26	$26.92	$26.92	$26.92
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $218.78 / $288.40	Professional		$134.90	$218.78	$288.40
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $44.67 / $60.26	Professional	26	$26.92	$44.67	$60.26
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $177.83 / $229.09	Professional	TC	$107.15	$177.83	$229.09
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $194.98 / $275.42	Professional		$134.90	$194.98	$275.42
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $42.66 / $54.95	Professional	26	$27.54	$42.66	$54.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $158.49 / $223.87	Professional	TC	$109.65	$158.49	$223.87
United Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $102.33 / $245.47	Professional		$75.86	$102.33	$245.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $22.39 / $51.29	Professional	26	$18.20	$22.39	$51.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $79.43 / $194.98	Professional	TC	$57.54	$79.43	$194.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $117.49 / $194.98	Professional		$102.33	$117.49	$194.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $22.91 / $38.02	Professional	26	$19.95	$22.91	$38.02
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $95.50 / $158.49	Professional	TC	$83.18	$95.50	$158.49