Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $57.54 / $125.89	Professional		$33.11	$57.54	$125.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $69.18 / $208.93	Professional	26	$26.92	$69.18	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.02 / $21.88 / $61.66	Professional	TC	$12.02	$21.88	$61.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $47.86 / $47.86	Professional		$47.86	$47.86	$47.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $57.54 / $93.33	Professional	26	$16.98	$57.54	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $57.54 / $81.28	Professional		$27.54	$57.54	$81.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $34.67 / $51.29	Professional	26	$17.78	$34.67	$51.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $22.39 / $28.84	Professional	TC	$10.00	$22.39	$28.84
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $81.28 / $724.44	Facility	26	$44.67	$81.28	$724.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $114.82 / $162.18	Professional		$74.13	$114.82	$162.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $70.79 / $95.50	Professional	26	$44.67	$70.79	$95.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $45.71 / $61.66	Professional	TC	$27.54	$45.71	$61.66
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $33.11 / $56.23	Professional		$21.88	$33.11	$56.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $67.61 / $70.79	Facility	26	$52.48	$67.61	$70.79
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $57.54 / $77.62	Professional	26	$41.69	$57.54	$77.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $32.36 / $43.65	Professional	TC	$25.70	$32.36	$43.65
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $125.89 / $151.36	Professional		$75.86	$125.89	$151.36
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $75.86 / $95.50	Professional	26	$47.86	$75.86	$95.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $45.71 / $57.54	Professional	TC	$29.51	$45.71	$57.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $97.72 / $128.82	Professional		$74.13	$97.72	$128.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $63.10 / $79.43	Professional	26	$46.77	$63.10	$79.43
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $38.02 / $50.12	Professional	TC	$26.30	$38.02	$50.12
United Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $53.70 / $117.49	Professional		$33.11	$53.70	$117.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $31.62 / $75.86	Professional	26	$20.42	$31.62	$75.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.75 / $19.50 / $39.81	Professional	TC	$11.75	$19.50	$39.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $56.23 / $56.23	Professional		$56.23	$56.23	$56.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $33.88 / $33.88	Professional	26	$33.88	$33.88	$33.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $21.88 / $21.88	Professional	TC	$21.88	$21.88	$21.88