Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $120.23 / $213.80	Professional		$91.20	$120.23	$213.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $15.14 / $18.20	Professional	26	$12.02	$15.14	$18.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $102.33 / $147.91	Professional	TC	$77.62	$102.33	$147.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $117.49 / $144.54	Professional		$114.82	$117.49	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $154.88 / $407.38	Professional		$93.33	$154.88	$407.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $20.89 / $43.65	Professional	26	$13.49	$20.89	$43.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $138.04 / $363.08	Professional	TC	$79.43	$138.04	$363.08
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $19.95 / $38.02	Facility	26	$13.80	$19.95	$38.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $141.25 / $302.00	Professional		$97.72	$141.25	$302.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $19.50 / $34.67	Professional	26	$13.80	$19.50	$34.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $125.89 / $269.15	Professional	TC	$79.43	$125.89	$269.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.12 / $33.11 / $89.13	Professional		$9.12	$33.11	$89.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $28.84 / $29.51	Facility	26	$23.99	$28.84	$29.51
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $24.55 / $29.51	Professional	26	$17.78	$24.55	$29.51
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $134.90 / $204.17	Professional	TC	$104.71	$134.90	$204.17
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $19.95 / $19.95	Facility	26	$19.95	$19.95	$19.95
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $302.00 / $389.05	Professional		$181.97	$302.00	$389.05
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $34.67 / $42.66	Professional	26	$20.89	$34.67	$42.66
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $263.03 / $338.84	Professional	TC	$162.18	$263.03	$338.84
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $138.04 / $251.19	Professional		$120.23	$138.04	$251.19
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $15.14 / $29.51	Professional	26	$14.79	$15.14	$29.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $123.03 / $223.87	Professional	TC	$104.71	$123.03	$223.87
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $162.18 / $309.03	Professional		$104.71	$162.18	$309.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $21.88 / $40.74	Professional	26	$14.79	$21.88	$40.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $138.04 / $269.15	Professional	TC	$89.13	$138.04	$269.15
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $162.18 / $199.53	Professional		$141.25	$162.18	$199.53
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $17.38 / $21.38	Professional	26	$15.14	$17.38	$21.38
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $144.54 / $177.83	Professional	TC	$125.89	$144.54	$177.83