Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $72.44 / $194.98	Professional		$50.12	$72.44	$194.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $31.62 / $281.84	Professional	26	$15.14	$31.62	$281.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $38.90 / $75.86	Professional	TC	$25.70	$38.90	$75.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $67.61 / $67.61	Professional		$67.61	$67.61	$67.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $24.55 / $52.48	Professional	26	$13.18	$24.55	$52.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $35.48 / $47.86	Professional	TC	$35.48	$35.48	$47.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $69.18 / $95.50	Professional		$35.48	$69.18	$95.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $28.84 / $40.74	Professional	26	$14.79	$28.84	$40.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $42.66 / $54.95	Professional	TC	$20.42	$42.66	$54.95
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $169.82 / $257.04	Facility		$83.18	$169.82	$257.04
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $81.28 / $234.42	Facility	26	$43.65	$81.28	$234.42
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $60.26 / $102.33 / $234.42	Facility	TC	$60.26	$102.33	$234.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $162.18 / $218.78	Professional		$104.71	$162.18	$218.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $69.18 / $114.82	Professional	26	$43.65	$69.18	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $93.33 / $123.03	Professional	TC	$60.26	$93.33	$123.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $32.36 / $40.74	Professional		$27.54	$32.36	$40.74
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $128.82 / $154.88	Facility		$109.65	$128.82	$154.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $53.70 / $95.50	Facility	26	$43.65	$53.70	$95.50
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $63.10 / $74.13 / $83.18	Facility	TC	$63.10	$74.13	$83.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $53.70 / $95.50	Professional	26	$37.15	$53.70	$95.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $66.07 / $85.11	Professional	TC	$46.77	$66.07	$85.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $151.36 / $181.97	Professional		$93.33	$151.36	$181.97
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $60.26 / $74.13	Professional	26	$37.15	$60.26	$74.13
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $89.13 / $109.65	Professional	TC	$56.23	$89.13	$109.65
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $123.03 / $169.82	Professional		$89.13	$123.03	$169.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $50.12 / $81.28	Professional	26	$37.15	$50.12	$81.28
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $72.44 / $95.50	Professional	TC	$53.70	$72.44	$95.50
United Facility/Professional Facility Modifier Low / Median / High Price $21.88 / $33.11 / $54.95	Facility		$21.88	$33.11	$54.95
United Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $67.61 / $141.25	Professional		$40.74	$67.61	$141.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $28.84 / $58.88	Professional	26	$16.22	$28.84	$58.88
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 $67.61 / $67.61 / $67.61	Professional		$67.61	$67.61	$67.61
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $26.30 / $26.30	Professional	26	$26.30	$26.30	$26.30
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $41.69 / $41.69	Professional	TC	$41.69	$41.69	$41.69