Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $51.29 / $85.11	Facility	26	$25.12	$51.29	$85.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $134.90 / $354.81	Professional		$93.33	$134.90	$354.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $112.20 / $295.12	Professional	TC	$77.62	$112.20	$295.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $204.17 / $426.58	Professional		$107.15	$204.17	$426.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $165.96 / $363.08	Professional	TC	$85.11	$165.96	$363.08
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $45.71 / $489.78	Facility	26	$26.92	$45.71	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $218.78 / $371.54	Professional		$109.65	$218.78	$371.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $173.78 / $316.23	Professional	TC	$87.10	$173.78	$316.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $75.86	Professional		$32.36	$33.11	$75.86
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $45.71 / $46.77	Facility	26	$35.48	$45.71	$46.77
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $117.49 / $269.15	Professional		$117.49	$117.49	$269.15
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $151.36 / $239.88	Professional	TC	$107.15	$151.36	$239.88
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	26	$30.90	$30.90	$30.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $309.03 / $407.38	Professional		$194.98	$309.03	$407.38
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $263.03 / $338.84	Professional	TC	$162.18	$263.03	$338.84
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.74 / $346.74 / $346.74	Facility	26	$346.74	$346.74	$346.74
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $281.84 / $398.11	Professional		$199.53	$281.84	$398.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $234.42 / $338.84	Professional	TC	$162.18	$234.42	$338.84
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $144.54 / $346.74	Professional		$104.71	$144.54	$346.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $117.49 / $281.84	Professional	TC	$85.11	$117.49	$281.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $173.78 / $288.40	Professional		$151.36	$173.78	$288.40
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $147.91 / $245.47	Professional	TC	$128.82	$147.91	$245.47