Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $134.90 / $389.05	Professional		$75.86	$134.90	$389.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $154.88 / $741.31	Professional	26	$39.81	$154.88	$741.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $83.18 / $223.87	Professional	TC	$46.77	$83.18	$223.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $114.82 / $251.19	Professional		$63.10	$114.82	$251.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $67.61 / $79.43	Professional	26	$19.50	$67.61	$79.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $93.33 / $169.82	Professional	TC	$93.33	$93.33	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $123.03 / $177.83	Professional		$61.66	$123.03	$177.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $41.69 / $58.88	Professional	26	$24.55	$41.69	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $83.18 / $114.82	Professional	TC	$38.02	$83.18	$114.82
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $295.12 / $724.44	Facility		$162.18	$295.12	$724.44
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $102.33 / $724.44	Facility	26	$69.18	$102.33	$724.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $257.04 / $354.81	Professional		$169.82	$257.04	$354.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $93.33 / $123.03	Professional	26	$69.18	$93.33	$123.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $169.82 / $239.88	Professional	TC	$100.00	$169.82	$239.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $56.23	Professional		$32.36	$33.11	$56.23
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $234.42 / $263.03	Facility		$190.55	$234.42	$263.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $81.28 / $102.33	Facility	26	$66.07	$81.28	$102.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $81.28 / $104.71	Professional	26	$60.26	$81.28	$104.71
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $120.23 / $186.21	Professional	TC	$93.33	$120.23	$186.21
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $269.15 / $323.59	Professional		$162.18	$269.15	$323.59
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $89.13 / $112.20	Professional	26	$56.23	$89.13	$112.20
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $181.97 / $213.80	Professional	TC	$109.65	$181.97	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $218.78 / $281.84	Professional		$162.18	$218.78	$281.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $77.62 / $100.00	Professional	26	$54.95	$77.62	$100.00
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $144.54 / $186.21	Professional	TC	$107.15	$144.54	$186.21
United Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $67.61 / $114.82	Facility		$45.71	$67.61	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $120.23 / $257.04	Professional		$70.79	$120.23	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $38.90 / $89.13	Professional	26	$24.55	$38.90	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $70.79 / $169.82	Professional	TC	$46.77	$70.79	$169.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Professional		$125.89	$125.89	$125.89
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $39.81 / $39.81	Professional	26	$39.81	$39.81	$39.81
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $85.11 / $85.11	Professional	TC	$85.11	$85.11	$85.11