Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $295.12 / $549.54	Professional		$144.54	$295.12	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $131.83 / $467.74	Professional	26	$77.62	$131.83	$467.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $125.89 / $204.17	Professional	TC	$67.61	$125.89	$204.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $239.88 / $323.59	Professional		$112.20	$239.88	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $123.03 / $181.97	Professional	26	$63.10	$123.03	$181.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $120.23 / $154.88	Professional	TC	$47.86	$120.23	$154.88
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $181.97 / $234.42 / $338.84	Facility	26	$181.97	$234.42	$338.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $524.81 / $676.08	Professional		$316.23	$524.81	$676.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $251.19 / $331.13	Professional	26	$181.97	$251.19	$331.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $239.88 / $354.81	Professional	TC	$128.82	$239.88	$354.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $79.43	Professional		$32.36	$33.11	$79.43
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $194.98 / $234.42 / $251.19	Facility	26	$194.98	$234.42	$251.19
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $213.80 / $257.04	Professional	26	$158.49	$213.80	$257.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $186.21 / $288.40	Professional	TC	$114.82	$186.21	$288.40
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $524.81 / $630.96	Professional		$316.23	$524.81	$630.96
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $263.03 / $331.13	Professional	26	$165.96	$263.03	$331.13
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $257.04 / $309.03	Professional	TC	$158.49	$257.04	$309.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $436.52 / $549.54	Professional		$331.13	$436.52	$549.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $229.09 / $275.42	Professional	26	$173.78	$229.09	$275.42
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $208.93 / $269.15	Professional	TC	$131.83	$208.93	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $223.87 / $489.78	Professional		$141.25	$223.87	$489.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $114.82 / $275.42	Professional	26	$72.44	$114.82	$275.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $107.15 / $218.78	Professional	TC	$64.57	$107.15	$218.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $229.09 / $229.09	Professional		$229.09	$229.09	$229.09
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $114.82 / $114.82	Professional	26	$114.82	$114.82	$114.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $117.49 / $117.49	Professional	TC	$117.49	$117.49	$117.49