Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $57.54 / $114.82	Facility	26	$45.71	$57.54	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $194.98 / $691.83	Professional		$107.15	$194.98	$691.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $44.67 / $151.36	Professional	26	$36.31	$44.67	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $131.83 / $331.13	Professional	TC	$66.07	$131.83	$331.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $398.11	Professional		$204.17	$204.17	$398.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $69.18 / $77.62	Professional	26	$33.11	$69.18	$77.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $208.93 / $380.19	Professional		$104.71	$208.93	$380.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $58.88 / $117.49	Professional	26	$33.88	$58.88	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $134.90 / $281.84	Professional	TC	$67.61	$134.90	$281.84
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $46.77 / $79.43 / $288.40	Facility	26	$46.77	$79.43	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $239.88 / $323.59	Professional		$138.04	$239.88	$323.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $75.86 / $102.33	Professional	26	$39.81	$75.86	$102.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $158.49 / $251.19	Professional	TC	$91.20	$158.49	$251.19
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 26 Low / Median / High Price $66.07 / $79.43 / $81.28	Facility	26	$66.07	$79.43	$81.28
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $72.44 / $89.13	Professional	26	$46.77	$72.44	$89.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $138.04 / $263.03	Professional	TC	$87.10	$138.04	$263.03
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $53.70 / $54.95	Facility	26	$53.70	$53.70	$54.95
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $245.47 / $323.59	Professional		$147.91	$245.47	$323.59
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $85.11 / $117.49	Professional	26	$54.95	$85.11	$117.49
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $154.88 / $204.17	Professional	TC	$95.50	$154.88	$204.17
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $229.09 / $309.03	Professional		$151.36	$229.09	$309.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $85.11 / $112.20	Professional	26	$56.23	$85.11	$112.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $147.91 / $199.53	Professional	TC	$95.50	$147.91	$199.53
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $158.49 / $316.23	Professional		$100.00	$158.49	$316.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $45.71 / $107.15	Professional	26	$34.67	$45.71	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $107.15 / $208.93	Professional	TC	$63.10	$107.15	$208.93
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $125.89 / $208.93	Professional		$109.65	$125.89	$208.93
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $45.71 / $75.86	Professional	26	$39.81	$45.71	$75.86
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $81.28 / $134.90	Professional	TC	$70.79	$81.28	$134.90