Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $181.97 / $371.54	Professional		$91.20	$181.97	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $23.99 / $64.57	Professional	26	$14.13	$23.99	$64.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $138.04 / $323.59	Professional	TC	$79.43	$138.04	$323.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $12.02 / $23.44	Professional	26	$12.02	$12.02	$23.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $204.17 / $204.17	Professional	TC	$204.17	$204.17	$204.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $208.93 / $263.03	Professional		$63.10	$208.93	$263.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $25.70 / $45.71	Professional	26	$13.18	$25.70	$45.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $162.18 / $239.88	Professional	TC	$50.12	$162.18	$239.88
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $60.26 / $102.33	Facility	26	$30.90	$60.26	$102.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $309.03 / $602.56	Professional		$181.97	$309.03	$602.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $60.26 / $102.33	Professional	26	$38.90	$60.26	$102.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $239.88 / $537.03	Professional	TC	$141.25	$239.88	$537.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $114.82	Professional		$32.36	$33.11	$114.82
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $45.71 / $102.33	Facility	26	$37.15	$45.71	$102.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $53.70 / $104.71	Professional	26	$33.88	$53.70	$104.71
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $190.55 / $338.84	Professional	TC	$125.89	$190.55	$338.84
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $457.09 / $549.54	Professional		$275.42	$457.09	$549.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $53.70 / $63.10	Professional	26	$31.62	$53.70	$63.10
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $398.11 / $489.78	Professional	TC	$245.47	$398.11	$489.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $371.54 / $467.74	Professional		$199.53	$371.54	$467.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $43.65 / $69.18	Professional	26	$31.62	$43.65	$69.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $323.59 / $416.87	Professional	TC	$158.49	$323.59	$416.87
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $181.97 / $371.54	Professional		$109.65	$181.97	$371.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $25.70 / $52.48	Professional	26	$14.13	$25.70	$52.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $138.04 / $323.59	Professional	TC	$93.33	$138.04	$323.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $194.98 / $194.98	Professional		$194.98	$194.98	$194.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $22.39 / $22.39	Professional	26	$22.39	$22.39	$22.39
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $173.78 / $173.78	Professional	TC	$173.78	$173.78	$173.78