Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $93.33 / $263.03	Professional		$47.86	$93.33	$263.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $44.67 / $154.88	Professional	26	$11.22	$44.67	$154.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $77.62 / $173.78	Professional	TC	$40.74	$77.62	$173.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $40.74 / $83.18	Professional		$40.74	$40.74	$83.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $19.50 / $22.91	Professional	26	$5.75	$19.50	$22.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $70.79 / $83.18	Professional	TC	$36.31	$70.79	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $85.11 / $109.65	Professional		$33.88	$85.11	$109.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.17 / $12.02 / $17.78	Professional	26	$6.17	$12.02	$17.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $74.13 / $95.50	Professional	TC	$28.18	$74.13	$95.50
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $151.36 / $218.78	Facility		$85.11	$151.36	$218.78
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $28.84 / $151.36	Facility	26	$14.79	$28.84	$151.36
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $70.79 / $144.54 / $181.97	Facility	TC	$70.79	$144.54	$181.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $165.96 / $218.78	Professional		$85.11	$165.96	$218.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $26.30 / $33.11	Professional	26	$14.79	$26.30	$33.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $138.04 / $190.55	Professional	TC	$70.79	$138.04	$190.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $50.12	Professional		$32.36	$33.11	$50.12
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $134.90 / $165.96	Facility		$100.00	$134.90	$165.96
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $22.91 / $23.44	Facility	26	$16.98	$22.91	$23.44
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $93.33 / $114.82 / $144.54	Facility	TC	$93.33	$114.82	$144.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $19.50 / $26.30	Professional	26	$14.13	$19.50	$26.30
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $97.72 / $138.04	Professional	TC	$72.44	$97.72	$138.04
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $181.97 / $223.87	Professional		$112.20	$181.97	$223.87
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $26.30 / $32.36	Professional	26	$15.85	$26.30	$32.36
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $154.88 / $190.55	Professional	TC	$97.72	$154.88	$190.55
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $147.91 / $190.55	Professional		$107.15	$147.91	$190.55
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $21.38 / $26.92	Professional	26	$16.22	$21.38	$26.92
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $125.89 / $165.96	Professional	TC	$89.13	$125.89	$165.96
United Facility/Professional Facility Modifier Low / Median / High Price $22.39 / $33.88 / $56.23	Facility		$22.39	$33.88	$56.23
United Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $72.44 / $158.49	Professional		$46.77	$72.44	$158.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $11.48 / $25.70	Professional	26	$7.08	$11.48	$25.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $61.66 / $131.83	Professional	TC	$38.90	$61.66	$131.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $85.11	Professional		$85.11	$85.11	$85.11
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $11.48 / $11.48	Professional	26	$11.48	$11.48	$11.48
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $72.44 / $72.44	Professional	TC	$72.44	$72.44	$72.44