Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $95.50 / $204.17	Professional		$60.26	$95.50	$204.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $32.36 / $93.33	Professional	26	$18.20	$32.36	$93.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $69.18 / $147.91	Professional	TC	$39.81	$69.18	$147.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $123.03 / $165.96	Professional		$37.15	$123.03	$165.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $32.36 / $42.66	Professional	26	$12.59	$32.36	$42.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $89.13 / $128.82	Professional	TC	$24.55	$89.13	$128.82
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $54.95 / $83.18	Facility	26	$33.88	$54.95	$83.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $204.17 / $354.81	Professional		$102.33	$204.17	$354.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $60.26 / $89.13	Professional	26	$34.67	$60.26	$89.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $144.54 / $269.15	Professional	TC	$69.18	$144.54	$269.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $61.66 / $64.57	Facility	26	$44.67	$61.66	$64.57
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $46.77 / $64.57	Professional	26	$36.31	$46.77	$64.57
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $158.49 / $194.98	Professional	TC	$87.10	$158.49	$194.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $269.15 / $338.84	Professional		$169.82	$269.15	$338.84
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $72.44 / $89.13	Professional	26	$43.65	$72.44	$89.13
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $194.98 / $251.19	Professional	TC	$123.03	$194.98	$251.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $208.93 / $295.12	Professional		$117.49	$208.93	$295.12
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $57.54 / $75.86	Professional	26	$39.81	$57.54	$75.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $154.88 / $223.87	Professional	TC	$83.18	$154.88	$223.87
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $100.00 / $239.88	Professional		$69.18	$100.00	$239.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $32.36 / $69.18	Professional	26	$19.50	$32.36	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $70.79 / $169.82	Professional	TC	$50.12	$70.79	$169.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $134.90 / $134.90	Professional		$134.90	$134.90	$134.90
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $33.11 / $33.11	Professional	26	$33.11	$33.11	$33.11
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $102.33 / $102.33	Professional	TC	$102.33	$102.33	$102.33