Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $81.28 / $467.74	Professional		$53.70	$81.28	$467.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $95.50 / $812.83	Professional	26	$34.67	$95.50	$812.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $46.77 / $239.88	Professional	TC	$26.92	$46.77	$239.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $60.26 / $138.04	Professional		$36.31	$60.26	$138.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $38.90 / $72.44	Professional	26	$17.78	$38.90	$72.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $37.15 / $72.44	Professional	TC	$18.62	$37.15	$72.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $74.13 / $107.15	Professional		$35.48	$74.13	$107.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $37.15 / $54.95	Professional	26	$19.95	$37.15	$54.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $37.15 / $57.54	Professional	TC	$16.98	$37.15	$57.54
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $70.79 / $162.18 / $229.09	Facility		$70.79	$162.18	$229.09
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $85.11 / $223.87	Facility	26	$39.81	$85.11	$223.87
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $31.62 / $77.62 / $223.87	Facility	TC	$31.62	$77.62	$223.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $151.36 / $204.17	Professional		$70.79	$151.36	$204.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $72.44 / $104.71	Professional	26	$39.81	$72.44	$104.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $74.13 / $95.50	Professional	TC	$31.62	$74.13	$95.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $33.11 / $58.88	Professional		$23.99	$33.11	$58.88
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $134.90 / $158.49	Facility		$109.65	$134.90	$158.49
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $72.44 / $74.13	Facility	26	$58.88	$72.44	$74.13
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $46.77 / $60.26 / $72.44	Facility	TC	$46.77	$60.26	$72.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $61.66 / $75.86	Professional	26	$43.65	$61.66	$75.86
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $56.23 / $112.20	Professional	TC	$38.02	$56.23	$112.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $162.18 / $194.98	Professional		$97.72	$162.18	$194.98
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $81.28 / $100.00	Professional	26	$50.12	$81.28	$100.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $75.86 / $95.50	Professional	TC	$48.98	$75.86	$95.50
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $131.83 / $186.21	Professional		$95.50	$131.83	$186.21
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $66.07 / $109.65	Professional	26	$50.12	$66.07	$109.65
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $63.10 / $109.65	Professional	TC	$45.71	$63.10	$109.65
United Facility/Professional Facility Modifier Low / Median / High Price $22.39 / $33.11 / $56.23	Facility		$22.39	$33.11	$56.23
United Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $70.79 / $144.54	Professional		$42.66	$70.79	$144.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $36.31 / $79.43	Professional	26	$21.88	$36.31	$79.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $32.36 / $66.07	Professional	TC	$19.05	$32.36	$66.07
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 $35.48 / $35.48 / $35.48	Professional	26	$35.48	$35.48	$35.48
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $37.15 / $37.15	Professional	TC	$37.15	$37.15	$37.15