Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $158.49 / $275.42	Professional		$89.13	$158.49	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $54.95 / $269.15	Professional	26	$19.95	$54.95	$269.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $87.10 / $257.04	Professional	TC	$51.29	$87.10	$257.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $162.18 / $162.18	Professional		$162.18	$162.18	$162.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $28.84 / $67.61	Professional	26	$28.84	$28.84	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $134.90 / $199.53	Professional		$47.86	$134.90	$199.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $35.48 / $51.29	Professional	26	$19.05	$35.48	$51.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $100.00 / $154.88	Professional	TC	$29.51	$100.00	$154.88
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $85.11 / $1,513.56	Facility	26	$56.23	$85.11	$1,513.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $234.42 / $446.68	Professional		$141.25	$234.42	$446.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $79.43 / $100.00	Professional	26	$56.23	$79.43	$100.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $144.54 / $354.81	Professional	TC	$79.43	$144.54	$354.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $74.13	Professional		$32.36	$33.11	$74.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $69.18 / $75.86	Facility	26	$57.54	$69.18	$75.86
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $64.57 / $85.11	Professional	26	$48.98	$64.57	$85.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $104.71 / $223.87	Professional	TC	$77.62	$104.71	$223.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $331.13 / $416.87	Professional		$204.17	$331.13	$416.87
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $77.62 / $95.50	Professional	26	$47.86	$77.62	$95.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $245.47 / $323.59	Professional	TC	$158.49	$245.47	$323.59
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $269.15 / $346.74	Professional		$165.96	$269.15	$346.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $67.61 / $81.28	Professional	26	$47.86	$67.61	$81.28
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $208.93 / $269.15	Professional	TC	$95.50	$208.93	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $109.65 / $263.03	Professional		$77.62	$109.65	$263.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $33.11 / $75.86	Professional	26	$21.38	$33.11	$75.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $70.79 / $186.21	Professional	TC	$54.95	$70.79	$186.21
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $144.54 / $144.54	Professional		$144.54	$144.54	$144.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $33.88 / $33.88	Professional	26	$33.88	$33.88	$33.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $109.65 / $109.65	Professional	TC	$109.65	$109.65	$109.65