Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $72.44 / $123.03	Facility	26	$36.31	$72.44	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $89.13 / $218.78	Professional		$61.66	$89.13	$218.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $34.67 / $128.82	Professional	26	$25.70	$34.67	$128.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $48.98 / $114.82	Professional	TC	$34.67	$48.98	$114.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.76 / $36.31 / $51.29	Facility	26	$7.76	$36.31	$51.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $138.04 / $239.88	Professional		$85.11	$138.04	$239.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $54.95 / $97.72	Professional	26	$33.88	$54.95	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $83.18 / $144.54	Professional	TC	$50.12	$83.18	$144.54
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $64.57 / $323.59	Facility	26	$38.02	$64.57	$323.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $158.49 / $213.80	Professional		$95.50	$158.49	$213.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $61.66 / $85.11	Professional	26	$35.48	$61.66	$85.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $97.72 / $131.83	Professional	TC	$60.26	$97.72	$131.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $63.10 / $67.61	Facility	26	$52.48	$63.10	$67.61
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $89.13 / $89.13	Professional		$89.13	$89.13	$89.13
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $58.88 / $74.13	Professional	26	$42.66	$58.88	$74.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $95.50 / $123.03	Professional	TC	$67.61	$95.50	$123.03
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $42.66 / $43.65	Facility	26	$42.66	$42.66	$43.65
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $165.96 / $218.78	Professional		$102.33	$165.96	$218.78
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $70.79 / $95.50	Professional	26	$43.65	$70.79	$95.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $97.72 / $125.89	Professional	TC	$58.88	$97.72	$125.89
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 $102.33 / $154.88 / $208.93	Professional		$102.33	$154.88	$208.93
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $66.07 / $87.10	Professional	26	$43.65	$66.07	$87.10
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $91.20 / $125.89	Professional	TC	$60.26	$91.20	$125.89
United Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $102.33 / $229.09	Professional		$83.18	$102.33	$229.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $37.15 / $83.18	Professional	26	$33.11	$37.15	$83.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $64.57 / $141.25	Professional	TC	$47.86	$64.57	$141.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $91.20 / $151.36	Professional		$19.95	$91.20	$151.36
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $38.02 / $63.10	Professional	26	$33.11	$38.02	$63.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $53.70 / $87.10	Professional	TC	$46.77	$53.70	$87.10