Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $100.00 / $363.08	Professional		$63.10	$100.00	$363.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $69.18 / $416.87	Professional	26	$26.92	$69.18	$416.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $70.79 / $204.17	Professional	TC	$40.74	$70.79	$204.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $109.65 / $194.98	Professional		$57.54	$109.65	$194.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $30.90 / $66.07	Professional	26	$16.60	$30.90	$66.07
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $43.65 / $95.50	Professional	TC	$43.65	$43.65	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $109.65 / $151.36	Professional		$51.29	$109.65	$151.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $34.67 / $52.48	Professional	26	$18.62	$34.67	$52.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $74.13 / $97.72	Professional	TC	$30.90	$74.13	$97.72
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $257.04 / $724.44	Facility		$131.83	$257.04	$724.44
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $85.11 / $724.44	Facility	26	$43.65	$85.11	$724.44
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $81.28 / $169.82 / $724.44	Facility	TC	$81.28	$169.82	$724.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $229.09 / $302.00	Professional		$131.83	$229.09	$302.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $77.62 / $100.00	Professional	26	$43.65	$77.62	$100.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $154.88 / $204.17	Professional	TC	$81.28	$154.88	$204.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $57.54	Professional		$32.36	$33.11	$57.54
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $199.53 / $213.80	Facility		$147.91	$199.53	$213.80
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $67.61 / $69.18	Facility	26	$54.95	$67.61	$69.18
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $95.50 / $131.83 / $144.54	Facility	TC	$95.50	$131.83	$144.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $60.26 / $77.62	Professional	26	$46.77	$60.26	$77.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $114.82 / $144.54	Professional	TC	$83.18	$114.82	$144.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $234.42 / $281.84	Professional		$144.54	$234.42	$281.84
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $75.86 / $93.33	Professional	26	$46.77	$75.86	$93.33
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 $138.04 / $181.97 / $245.47	Professional		$138.04	$181.97	$245.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $63.10 / $77.62	Professional	26	$45.71	$63.10	$77.62
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $120.23 / $169.82	Professional	TC	$85.11	$120.23	$169.82
United Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $52.48 / $87.10	Facility		$34.67	$52.48	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $100.00 / $218.78	Professional		$60.26	$100.00	$218.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $32.36 / $75.86	Professional	26	$20.42	$32.36	$75.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $60.26 / $144.54	Professional	TC	$39.81	$60.26	$144.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $114.82 / $114.82	Professional		$114.82	$114.82	$114.82
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $33.11 / $33.11	Professional	26	$33.11	$33.11	$33.11
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $81.28 / $81.28	Professional	TC	$81.28	$81.28	$81.28