Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $31.62 / $85.11	Facility	26	$19.95	$31.62	$85.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $56.23 / $100.00	Professional		$42.66	$56.23	$100.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $15.85 / $34.67	Professional	26	$12.88	$15.85	$34.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $40.74 / $69.18	Professional	TC	$30.20	$40.74	$69.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $83.18 / $147.91	Professional		$52.48	$83.18	$147.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $25.12 / $46.77	Professional	26	$15.85	$25.12	$46.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $58.88 / $100.00	Professional	TC	$37.15	$58.88	$100.00
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $19.50 / $36.31	Facility	26	$14.13	$19.50	$36.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $66.07 / $112.20	Professional		$48.98	$66.07	$112.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $19.05 / $33.11	Professional	26	$13.80	$19.05	$33.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $47.86 / $79.43	Professional	TC	$34.67	$47.86	$79.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.33 / $32.36 / $33.11	Professional		$9.33	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $22.39 / $26.92 / $30.20	Facility	26	$22.39	$26.92	$30.20
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $24.55 / $32.36	Professional	26	$19.05	$24.55	$32.36
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $58.88 / $75.86	Professional	TC	$43.65	$58.88	$75.86
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $19.05 / $19.50	Facility	26	$19.05	$19.05	$19.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $89.13 / $123.03	Professional		$60.26	$89.13	$123.03
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $28.84 / $39.81	Professional	26	$19.05	$28.84	$39.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $61.66 / $83.18	Professional	TC	$40.74	$61.66	$83.18
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $72.44 / $72.44	Facility	26	$72.44	$72.44	$72.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $85.11 / $117.49	Professional		$64.57	$85.11	$117.49
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $26.30 / $37.15	Professional	26	$19.95	$26.30	$37.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $58.88 / $81.28	Professional	TC	$45.71	$58.88	$81.28
United Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $77.62 / $131.83	Professional		$52.48	$77.62	$131.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $23.44 / $40.74	Professional	26	$16.22	$23.44	$40.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $54.95 / $91.20	Professional	TC	$37.15	$54.95	$91.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $46.77 / $77.62	Professional		$41.69	$46.77	$77.62
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $14.45 / $25.70	Professional	26	$13.49	$14.45	$25.70
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $32.36 / $52.48	Professional	TC	$27.54	$32.36	$52.48