Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $81.28 / $199.53	Professional		$42.66	$81.28	$199.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $40.74 / $177.83	Professional	26	$16.98	$40.74	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $48.98 / $138.04	Professional	TC	$25.70	$48.98	$138.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $35.48 / $35.48	Professional		$35.48	$35.48	$35.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $18.62 / $58.88	Professional	26	$10.72	$18.62	$58.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $70.79 / $91.20	Professional		$31.62	$70.79	$91.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $22.39 / $31.62	Professional	26	$11.75	$22.39	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $46.77 / $63.10	Professional	TC	$19.50	$46.77	$63.10
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $151.36 / $204.17	Facility		$74.13	$151.36	$204.17
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $51.29 / $158.49	Facility	26	$30.90	$51.29	$158.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $144.54 / $194.98	Professional		$93.33	$144.54	$194.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $43.65 / $60.26	Professional	26	$30.90	$43.65	$60.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $95.50 / $134.90	Professional	TC	$57.54	$95.50	$134.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $41.69	Professional		$32.36	$32.36	$41.69
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $117.49 / $144.54	Facility		$93.33	$117.49	$144.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $42.66 / $50.12	Facility	26	$35.48	$42.66	$50.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $39.81 / $48.98	Professional	26	$26.30	$39.81	$48.98
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $70.79 / $100.00	Professional	TC	$51.29	$70.79	$100.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $144.54 / $181.97	Professional		$93.33	$144.54	$181.97
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $48.98 / $60.26	Professional	26	$30.20	$48.98	$60.26
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $100.00 / $123.03	Professional	TC	$64.57	$100.00	$123.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $120.23 / $158.49	Professional		$87.10	$120.23	$158.49
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $40.74 / $50.12	Professional	26	$30.20	$40.74	$50.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $83.18 / $109.65	Professional	TC	$57.54	$83.18	$109.65
United Facility/Professional Facility Modifier Low / Median / High Price $20.42 / $30.20 / $51.29	Facility		$20.42	$30.20	$51.29
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $63.10 / $128.82	Professional		$38.02	$63.10	$128.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $21.38 / $47.86	Professional	26	$13.18	$21.38	$47.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $39.81 / $81.28	Professional	TC	$23.99	$39.81	$81.28
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $72.44	Professional		$72.44	$72.44	$72.44
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $21.88 / $21.88	Professional	26	$21.88	$21.88	$21.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $50.12 / $50.12	Professional	TC	$50.12	$50.12	$50.12