Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $239.88 / $575.44	Professional		$194.98	$239.88	$575.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $52.48 / $251.19	Professional	26	$32.36	$52.48	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $208.93 / $724.44	Professional	TC	$165.96	$208.93	$724.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $21.38 / $42.66	Professional	26	$21.38	$21.38	$42.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $275.42 / $275.42	Professional	TC	$275.42	$275.42	$275.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $295.12 / $398.11	Professional		$102.33	$295.12	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $41.69 / $60.26	Professional	26	$22.39	$41.69	$60.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $257.04 / $346.74	Professional	TC	$79.43	$257.04	$346.74
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $100.00 / $724.44	Facility	26	$60.26	$100.00	$724.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $575.44 / $912.01	Professional		$302.00	$575.44	$912.01
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $85.11 / $114.82	Professional	26	$60.26	$85.11	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $489.78 / $812.83	Professional	TC	$239.88	$489.78	$812.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $154.88	Professional		$32.36	$33.11	$154.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $81.28 / $87.10	Facility	26	$66.07	$81.28	$87.10
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $66.07 / $87.10	Professional	26	$53.70	$66.07	$87.10
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $426.58 / $562.34	Professional	TC	$354.81	$426.58	$562.34
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $645.65 / $870.96	Professional		$389.05	$645.65	$870.96
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $91.20 / $114.82	Professional	26	$57.54	$91.20	$114.82
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $549.54 / $741.31	Professional	TC	$338.84	$549.54	$741.31
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $562.34 / $724.44	Professional		$323.59	$562.34	$724.44
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $77.62 / $95.50	Professional	26	$57.54	$77.62	$95.50
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $489.78 / $645.65	Professional	TC	$257.04	$489.78	$645.65
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $269.15 / $707.95	Professional		$173.78	$269.15	$707.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $39.81 / $93.33	Professional	26	$25.12	$39.81	$93.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $229.09 / $616.60	Professional	TC	$147.91	$229.09	$616.60
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $281.84 / $281.84	Professional		$281.84	$281.84	$281.84
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 $239.88 / $239.88 / $239.88	Professional	TC	$239.88	$239.88	$239.88