Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $60.26 / $138.04	Professional		$44.67	$60.26	$138.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $25.12 / $77.62	Professional	26	$15.14	$25.12	$77.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $40.74 / $91.20	Professional	TC	$28.18	$40.74	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $81.28 / $104.71	Professional		$30.20	$81.28	$104.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $25.12 / $35.48	Professional	26	$12.88	$25.12	$35.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $53.70 / $75.86	Professional	TC	$17.38	$53.70	$75.86
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $56.23 / $114.82	Facility	26	$34.67	$56.23	$114.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $144.54 / $223.87	Professional		$79.43	$144.54	$223.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $50.12 / $69.18	Professional	26	$34.67	$50.12	$69.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $95.50 / $154.88	Professional	TC	$48.98	$95.50	$154.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $50.12	Professional		$32.36	$33.11	$50.12
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $45.71 / $48.98	Facility	26	$35.48	$45.71	$48.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $43.65 / $58.88	Professional	26	$32.36	$43.65	$58.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $58.88 / $102.33	Professional	TC	$42.66	$58.88	$102.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $173.78 / $213.80	Professional		$107.15	$173.78	$213.80
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $54.95 / $67.61	Professional	26	$33.11	$54.95	$67.61
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $112.20 / $151.36	Professional	TC	$72.44	$112.20	$151.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $131.83 / $190.55	Professional		$89.13	$131.83	$190.55
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $44.67 / $56.23	Professional	26	$33.88	$44.67	$56.23
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $87.10 / $131.83	Professional	TC	$50.12	$87.10	$131.83
United Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $58.88 / $141.25	Professional		$41.69	$58.88	$141.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $23.99 / $53.70	Professional	26	$15.14	$23.99	$53.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $37.15 / $89.13	Professional	TC	$25.70	$37.15	$89.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Professional		$87.10	$87.10	$87.10
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $24.55 / $24.55	Professional	26	$24.55	$24.55	$24.55
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $61.66 / $61.66	Professional	TC	$61.66	$61.66	$61.66