Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $47.86 / $173.78	Professional		$27.54	$47.86	$173.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $25.70 / $95.50	Professional	26	$7.94	$25.70	$95.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $35.48 / $95.50	Professional	TC	$19.95	$35.48	$95.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $36.31 / $85.11	Professional		$21.38	$36.31	$85.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.37 / $11.75 / $21.38	Professional	26	$5.37	$11.75	$21.38
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $37.15 / $64.57	Professional	TC	$37.15	$37.15	$64.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $44.67 / $64.57	Professional		$20.89	$44.67	$64.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.89 / $11.22 / $16.60	Professional	26	$5.89	$11.22	$16.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $33.11 / $48.98	Professional	TC	$14.79	$33.11	$48.98
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $97.72 / $223.87	Facility		$50.12	$97.72	$223.87
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $26.30 / $223.87	Facility	26	$14.45	$26.30	$223.87
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $35.48 / $72.44 / $223.87	Facility	TC	$35.48	$72.44	$223.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $91.20 / $125.89	Professional		$50.12	$91.20	$125.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $22.39 / $30.90	Professional	26	$14.45	$22.39	$30.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $69.18 / $95.50	Professional	TC	$35.48	$69.18	$95.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $32.36 / $33.11	Professional		$21.38	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $81.28 / $112.20	Facility		$66.07	$81.28	$112.20
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $18.20 / $21.88 / $22.91	Facility	26	$18.20	$21.88	$22.91
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $46.77 / $58.88 / $64.57	Facility	TC	$46.77	$58.88	$64.57
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $19.50 / $25.12	Professional	26	$14.13	$19.50	$25.12
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $57.54 / $89.13	Professional	TC	$40.74	$57.54	$89.13
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $95.50 / $117.49	Professional		$58.88	$95.50	$117.49
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $24.55 / $30.20	Professional	26	$15.14	$24.55	$30.20
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $69.18 / $87.10	Professional	TC	$43.65	$69.18	$87.10
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $79.43 / $102.33	Professional		$56.23	$79.43	$102.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $20.42 / $25.70	Professional	26	$15.14	$20.42	$25.70
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $58.88 / $85.11	Professional	TC	$40.74	$58.88	$85.11
United Facility/Professional Facility Modifier Low / Median / High Price $13.18 / $19.95 / $33.11	Facility		$13.18	$19.95	$33.11
United Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $40.74 / $85.11	Professional		$25.12	$40.74	$85.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $10.23 / $24.55	Professional	26	$6.76	$10.23	$24.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $30.20 / $61.66	Professional	TC	$17.78	$30.20	$61.66
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $42.66 / $42.66	Professional		$42.66	$42.66	$42.66
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $10.47 / $10.47	Professional	26	$10.47	$10.47	$10.47
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $32.36 / $32.36	Professional	TC	$32.36	$32.36	$32.36