Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $57.54 / $123.03	Professional		$42.66	$57.54	$123.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $21.38 / $70.79	Professional	26	$15.14	$21.38	$70.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $34.67 / $75.86	Professional	TC	$26.92	$34.67	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $69.18 / $91.20	Professional		$30.20	$69.18	$91.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $24.55 / $33.88	Professional	26	$10.47	$24.55	$33.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $44.67 / $60.26	Professional	TC	$19.50	$44.67	$60.26
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $46.77 / $70.79	Facility	26	$28.18	$46.77	$70.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $144.54 / $204.17	Professional		$85.11	$144.54	$204.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $47.86 / $70.79	Professional	26	$29.51	$47.86	$70.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $95.50 / $134.90	Professional	TC	$54.95	$95.50	$134.90
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 $39.81 / $48.98 / $53.70	Facility	26	$39.81	$48.98	$53.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $41.69 / $53.70	Professional	26	$32.36	$41.69	$53.70
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $81.28 / $102.33	Professional	TC	$63.10	$81.28	$102.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $151.36 / $186.21	Professional		$91.20	$151.36	$186.21
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 $58.88 / $97.72 / $120.23	Professional	TC	$58.88	$97.72	$120.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $125.89 / $158.49	Professional		$93.33	$125.89	$158.49
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $45.71 / $56.23	Professional	26	$33.88	$45.71	$56.23
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $79.43 / $100.00	Professional	TC	$60.26	$79.43	$100.00
United Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $63.10 / $154.88	Professional		$41.69	$63.10	$154.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $23.44 / $56.23	Professional	26	$14.45	$23.44	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $40.74 / $95.50	Professional	TC	$26.92	$40.74	$95.50
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $66.07 / $66.07	Professional		$66.07	$66.07	$66.07
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $23.99 / $23.99	Professional	26	$23.99	$23.99	$23.99
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $41.69 / $41.69	Professional	TC	$41.69	$41.69	$41.69