Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $67.61 / $138.04	Professional		$48.98	$67.61	$138.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $26.92 / $66.07	Professional	26	$20.89	$26.92	$66.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $37.15 / $67.61	Professional	TC	$25.70	$37.15	$67.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $123.03 / $141.25	Professional		$61.66	$123.03	$141.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $47.86 / $53.70	Professional	26	$46.77	$47.86	$53.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $91.20 / $194.98	Professional		$57.54	$91.20	$194.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $37.15 / $79.43	Professional	26	$24.55	$37.15	$79.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $54.95 / $114.82	Professional	TC	$32.36	$54.95	$114.82
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $91.20 / $162.18	Facility		$63.10	$91.20	$162.18
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $26.30 / $36.31 / $69.18	Facility	26	$26.30	$36.31	$69.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $89.13 / $154.88	Professional		$63.10	$89.13	$154.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $36.31 / $63.10	Professional	26	$25.70	$36.31	$63.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $52.48 / $91.20	Professional	TC	$36.31	$52.48	$91.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $32.36 / $41.69	Professional		$16.98	$32.36	$41.69
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $123.03 / $131.83	Facility		$95.50	$123.03	$131.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $52.48 / $52.48	Facility	26	$43.65	$52.48	$52.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $45.71 / $58.88	Professional	26	$31.62	$45.71	$58.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $63.10 / $93.33	Professional	TC	$42.66	$63.10	$93.33
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $83.18 / $83.18	Facility		$83.18	$83.18	$83.18
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $35.48 / $35.48	Facility	26	$35.48	$35.48	$35.48
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $147.91 / $181.97	Professional		$87.10	$147.91	$181.97
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $63.10 / $75.86	Professional	26	$37.15	$63.10	$75.86
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $85.11 / $107.15	Professional	TC	$51.29	$85.11	$107.15
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $123.03 / $162.18	Professional		$85.11	$123.03	$162.18
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $50.12 / $67.61	Professional	26	$36.31	$50.12	$67.61
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $70.79 / $93.33	Professional	TC	$48.98	$70.79	$93.33
United Facility/Professional Facility Modifier Low / Median / High Price $676.08 / $676.08 / $676.08	Facility		$676.08	$676.08	$676.08
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $95.50 / $165.96	Professional		$63.10	$95.50	$165.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $39.81 / $74.13	Professional	26	$27.54	$39.81	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $54.95 / $95.50	Professional	TC	$36.31	$54.95	$95.50
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $66.07 / $93.33	Professional		$16.98	$66.07	$93.33
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $30.90 / $38.02	Professional	26	$26.92	$30.90	$38.02
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $44.67 / $54.95	Professional	TC	$38.90	$44.67	$54.95