Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $147.91 / $288.40	Professional		$83.18	$147.91	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $61.66 / $234.42	Professional	26	$30.20	$61.66	$234.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $107.15 / $169.82	Professional	TC	$53.70	$107.15	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $151.36 / $218.78	Professional		$61.66	$151.36	$218.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $41.69 / $69.18	Professional	26	$21.88	$41.69	$69.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $112.20 / $151.36	Professional	TC	$40.74	$112.20	$151.36
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $100.00 / $1,513.56	Facility	26	$63.10	$100.00	$1,513.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $331.13 / $467.74	Professional		$173.78	$331.13	$467.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $93.33 / $123.03	Professional	26	$63.10	$93.33	$123.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $234.42 / $346.74	Professional	TC	$112.20	$234.42	$346.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $72.44	Professional		$32.36	$33.11	$72.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $81.28 / $117.49	Facility	26	$67.61	$81.28	$117.49
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $93.33 / $114.82	Professional	26	$58.88	$93.33	$114.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $218.78 / $295.12	Professional	TC	$107.15	$218.78	$295.12
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $316.23 / $389.05	Professional		$199.53	$316.23	$389.05
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $91.20 / $112.20	Professional	26	$56.23	$91.20	$112.20
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $223.87 / $281.84	Professional	TC	$144.54	$223.87	$281.84
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $251.19 / $346.74	Professional		$173.78	$251.19	$346.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $74.13 / $107.15	Professional	26	$54.95	$74.13	$107.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $186.21 / $251.19	Professional	TC	$107.15	$186.21	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $134.90 / $275.42	Professional		$79.43	$134.90	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $41.69 / $89.13	Professional	26	$24.55	$41.69	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $91.20 / $186.21	Professional	TC	$54.95	$91.20	$186.21
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $151.36 / $151.36	Professional		$151.36	$151.36	$151.36
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $40.74 / $40.74	Professional	26	$40.74	$40.74	$40.74
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $112.20 / $112.20	Professional	TC	$112.20	$112.20	$112.20