Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $173.78 / $331.13	Facility	26	$104.71	$173.78	$331.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $154.88 / $426.58	Professional		$95.50	$154.88	$426.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $58.88 / $151.36	Professional	TC	$33.88	$58.88	$151.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $302.00 / $446.68	Professional		$169.82	$302.00	$446.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $112.20 / $177.83	Professional	TC	$57.54	$112.20	$177.83
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $120.23 / $213.80 / $1,122.02	Facility	26	$120.23	$213.80	$1,122.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $302.00 / $416.87	Professional		$190.55	$302.00	$416.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $112.20 / $154.88	Professional	TC	$69.18	$112.20	$154.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $58.88	Professional		$32.36	$33.11	$58.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $151.36 / $181.97 / $186.21	Facility	26	$151.36	$181.97	$186.21
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $81.28 / $104.71	Professional	TC	$54.95	$81.28	$104.71
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $125.89 / $125.89	Facility	26	$125.89	$125.89	$125.89
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $331.13 / $426.58	Professional		$199.53	$331.13	$426.58
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $120.23 / $154.88	Professional	TC	$74.13	$120.23	$154.88
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $489.78 / $489.78 / $489.78	Facility	26	$489.78	$489.78	$489.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $309.03 / $416.87	Professional		$199.53	$309.03	$416.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $112.20 / $151.36	Professional	TC	$72.44	$112.20	$151.36
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $158.49 / $407.38	Professional		$123.03	$158.49	$407.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $57.54 / $138.04	Professional	TC	$40.74	$57.54	$138.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $199.53 / $281.84	Professional		$147.91	$199.53	$281.84
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $75.86 / $104.71	Professional	TC	$56.23	$75.86	$104.71