Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.98 / $4.90 / $12.59	Facility	26	$3.98	$4.90	$12.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.88 / $22.91 / $41.69	Professional		$12.88	$22.91	$41.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.00 / $3.98 / $12.30	Professional	26	$2.00	$3.98	$12.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $16.98 / $28.18	Professional	TC	$10.96	$16.98	$28.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $31.62 / $53.70	Professional		$17.78	$31.62	$53.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.39 / $6.46 / $10.72	Professional	26	$3.39	$6.46	$10.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $25.70 / $43.65	Professional	TC	$14.79	$25.70	$43.65
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $4.47 / $6.46 / $14.13	Facility	26	$4.47	$6.46	$14.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $30.90 / $52.48	Professional		$19.50	$30.90	$52.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $3.80 / $5.89 / $10.72	Professional	26	$3.80	$5.89	$10.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $24.55 / $41.69	Professional	TC	$15.85	$24.55	$41.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $2.04 / $32.36 / $33.11	Professional		$2.04	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $4.37 / $5.37 / $10.72	Facility	26	$4.37	$5.37	$10.72
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $5.13 / $7.94 / $10.72	Professional	26	$5.13	$7.94	$10.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $28.84 / $38.02	Professional	TC	$19.50	$28.84	$38.02
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $3.63 / $3.63 / $4.07	Facility	26	$3.63	$3.63	$4.07
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $30.90 / $43.65	Professional		$20.42	$30.90	$43.65
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $3.63 / $5.62 / $7.94	Professional	26	$3.63	$5.62	$7.94
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $25.12 / $36.31	Professional	TC	$16.98	$25.12	$36.31
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $107.15 / $107.15	Facility	26	$107.15	$107.15	$107.15
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $29.51 / $45.71	Professional		$20.89	$29.51	$45.71
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $4.07 / $5.62 / $10.00	Professional	26	$4.07	$5.62	$10.00
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $23.44 / $37.15	Professional	TC	$16.60	$23.44	$37.15
United Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $31.62 / $46.77	Professional		$19.05	$31.62	$46.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $3.63 / $6.92 / $9.55	Professional	26	$3.63	$6.92	$9.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $25.12 / $37.15	Professional	TC	$15.14	$25.12	$37.15
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $19.50 / $32.36	Professional		$16.98	$19.50	$32.36
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $2.63 / $3.02 / $5.01	Professional	26	$2.63	$3.02	$5.01
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $16.60 / $26.92	Professional	TC	$14.45	$16.60	$26.92