Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $131.83 / $218.78	Facility	26	$91.20	$131.83	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $309.03 / $645.65	Professional		$190.55	$309.03	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $67.61 / $208.93	Professional	26	$50.12	$67.61	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $218.78 / $537.03	Professional	TC	$141.25	$218.78	$537.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $478.63 / $741.31	Professional		$281.84	$478.63	$741.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $123.03 / $186.21	Professional	26	$74.13	$123.03	$186.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $354.81 / $575.44	Professional	TC	$208.93	$354.81	$575.44
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $120.23 / $158.49	Facility	26	$75.86	$120.23	$158.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $489.78 / $676.08	Professional		$295.12	$489.78	$676.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $131.83 / $169.82	Professional	26	$79.43	$131.83	$169.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $363.08 / $501.19	Professional	TC	$213.80	$363.08	$501.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $95.50	Professional		$32.36	$33.11	$95.50
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $120.23 / $123.03	Facility	26	$100.00	$120.23	$123.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $104.71 / $131.83	Professional	26	$72.44	$104.71	$131.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $295.12 / $691.83	Professional	TC	$190.55	$295.12	$691.83
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $81.28 / $83.18	Facility	26	$81.28	$81.28	$83.18
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $501.19 / $630.96	Professional		$302.00	$501.19	$630.96
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $138.04 / $177.83	Professional	26	$83.18	$138.04	$177.83
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $363.08 / $457.09	Professional	TC	$218.78	$363.08	$457.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $478.63 / $645.65	Professional		$309.03	$478.63	$645.65
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $128.82 / $173.78	Professional	26	$83.18	$128.82	$173.78
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $354.81 / $478.63	Professional	TC	$229.09	$354.81	$478.63
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $309.03 / $676.08	Professional		$190.55	$309.03	$676.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $64.57 / $162.18	Professional	26	$48.98	$64.57	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $234.42 / $537.03	Professional	TC	$138.04	$234.42	$537.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $309.03 / $436.52	Professional		$229.09	$309.03	$436.52
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $83.18 / $114.82	Professional	26	$61.66	$83.18	$114.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $229.09 / $323.59	Professional	TC	$169.82	$229.09	$323.59