Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $32.36 / $89.13	Facility	26	$19.95	$32.36	$89.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $45.71 / $89.13	Professional		$26.30	$45.71	$89.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $16.98 / $46.77	Professional	26	$12.88	$16.98	$46.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.02 / $30.90 / $58.88	Professional	TC	$12.02	$30.90	$58.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $61.66 / $154.88	Professional		$33.88	$61.66	$154.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $23.99 / $47.86	Professional	26	$15.85	$23.99	$47.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $41.69 / $102.33	Professional	TC	$15.49	$41.69	$102.33
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $17.78 / $32.36	Facility	26	$13.49	$17.78	$32.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $37.15 / $100.00	Professional		$25.12	$37.15	$100.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $18.20 / $33.11	Professional	26	$13.18	$18.20	$33.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $11.22 / $17.38 / $70.79	Professional	TC	$11.22	$17.38	$70.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $32.36 / $33.11	Professional		$9.77	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $23.44 / $28.18 / $29.51	Facility	26	$23.44	$28.18	$29.51
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $24.55 / $30.20	Professional	26	$17.38	$24.55	$30.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $13.80 / $20.89 / $53.70	Professional	TC	$13.80	$20.89	$53.70
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $19.50 / $19.50 / $19.95	Facility	26	$19.50	$19.50	$19.95
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $91.20 / $128.82	Professional		$61.66	$91.20	$128.82
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $29.51 / $41.69	Professional	26	$19.50	$29.51	$41.69
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $63.10 / $87.10	Professional	TC	$41.69	$63.10	$87.10
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $79.43 / $120.23	Professional		$56.23	$79.43	$120.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $26.92 / $38.02	Professional	26	$20.42	$26.92	$38.02
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $53.70 / $81.28	Professional	TC	$32.36	$53.70	$81.28
United Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $57.54 / $114.82	Professional		$34.67	$57.54	$114.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $22.91 / $41.69	Professional	26	$15.85	$22.91	$41.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $35.48 / $79.43	Professional	TC	$16.22	$35.48	$79.43
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $52.48 / $87.10	Professional		$45.71	$52.48	$87.10
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $15.85 / $27.54	Professional	26	$14.79	$15.85	$27.54
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $37.15 / $60.26	Professional	TC	$31.62	$37.15	$60.26