Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $87.10 / $141.25	Facility	26	$43.65	$87.10	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $114.82 / $275.42	Professional		$72.44	$114.82	$275.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $72.44 / $173.78	Professional	TC	$45.71	$72.44	$173.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $190.55 / $331.13	Professional		$93.33	$190.55	$331.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $134.90 / $218.78	Professional	TC	$56.23	$134.90	$218.78
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $77.62 / $1,698.24	Facility	26	$44.67	$77.62	$1,698.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $199.53 / $288.40	Professional		$107.15	$199.53	$288.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $125.89 / $190.55	Professional	TC	$69.18	$125.89	$190.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $56.23	Professional		$32.36	$33.11	$56.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $77.62 / $79.43	Facility	26	$64.57	$77.62	$79.43
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $120.23 / $169.82	Professional	TC	$72.44	$120.23	$169.82
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $52.48 / $53.70	Facility	26	$52.48	$52.48	$53.70
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $245.47 / $316.23	Professional		$147.91	$245.47	$316.23
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $158.49 / $204.17	Professional	TC	$95.50	$158.49	$204.17
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,380.38 / $1,380.38 / $1,380.38	Facility	26	$1,380.38	$1,380.38	$1,380.38
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $229.09 / $309.03	Professional		$151.36	$229.09	$309.03
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $144.54 / $194.98	Professional	TC	$97.72	$144.54	$194.98
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $134.90 / $281.84	Professional		$100.00	$134.90	$281.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $89.13 / $177.83	Professional	TC	$60.26	$89.13	$177.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $131.83 / $218.78	Professional		$114.82	$131.83	$218.78
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $85.11 / $141.25	Professional	TC	$74.13	$85.11	$141.25