Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $100.00 / $204.17	Professional		$57.54	$100.00	$204.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $114.82 / $426.58	Professional	26	$46.77	$114.82	$426.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $37.15 / $66.07	Professional	TC	$19.05	$37.15	$66.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $50.12 / $100.00	Professional	26	$29.51	$50.12	$100.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $26.92 / $26.92	Professional	TC	$26.92	$26.92	$26.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $93.33 / $128.82	Professional		$45.71	$93.33	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $61.66 / $87.10	Professional	26	$32.36	$61.66	$87.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $32.36 / $42.66	Professional	TC	$14.13	$32.36	$42.66
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $144.54 / $3,630.78	Facility	26	$85.11	$144.54	$3,630.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $208.93 / $269.15	Professional		$128.82	$208.93	$269.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $123.03 / $169.82	Professional	26	$85.11	$123.03	$169.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $69.18 / $100.00	Professional	TC	$38.02	$69.18	$100.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $53.70	Professional		$32.36	$33.11	$53.70
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $120.23 / $123.03	Facility	26	$97.72	$120.23	$123.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $102.33 / $134.90	Professional	26	$81.28	$102.33	$134.90
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $53.70 / $75.86	Professional	TC	$35.48	$53.70	$75.86
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $204.17 / $251.19	Professional		$128.82	$204.17	$251.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $134.90 / $165.96	Professional	26	$83.18	$134.90	$165.96
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $72.44 / $89.13	Professional	TC	$43.65	$72.44	$89.13
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $173.78 / $213.80	Professional		$125.89	$173.78	$213.80
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $109.65 / $138.04	Professional	26	$83.18	$109.65	$138.04
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $60.26 / $79.43	Professional	TC	$43.65	$60.26	$79.43
United Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $89.13 / $186.21	Professional		$54.95	$89.13	$186.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $57.54 / $131.83	Professional	26	$36.31	$57.54	$131.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $26.92 / $54.95	Professional	TC	$15.85	$26.92	$54.95
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $91.20 / $91.20	Professional		$91.20	$91.20	$91.20
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $58.88 / $58.88	Professional	26	$58.88	$58.88	$58.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $32.36 / $32.36	Professional	TC	$32.36	$32.36	$32.36