Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $100.00 / $239.88	Facility	26	$60.26	$100.00	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $288.40 / $602.56	Professional		$173.78	$288.40	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $85.11 / $245.47	Professional	26	$52.48	$85.11	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $218.78 / $416.87	Professional	TC	$123.03	$218.78	$416.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $302.00	Professional		$128.82	$128.82	$302.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $39.81 / $93.33	Professional	26	$39.81	$39.81	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $363.08 / $676.08	Professional		$190.55	$363.08	$676.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $87.10 / $158.49	Professional	26	$44.67	$87.10	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $281.84 / $537.03	Professional	TC	$138.04	$281.84	$537.03
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $112.20 / $489.78	Facility	26	$75.86	$112.20	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $467.74 / $630.96	Professional		$275.42	$467.74	$630.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $107.15 / $147.91	Professional	26	$64.57	$107.15	$147.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $354.81 / $489.78	Professional	TC	$208.93	$354.81	$489.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $83.18	Professional		$32.36	$33.11	$83.18
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $104.71 / $131.83	Facility	26	$87.10	$104.71	$131.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $107.15 / $134.90	Professional	26	$77.62	$107.15	$134.90
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $346.74 / $478.63	Professional	TC	$234.42	$346.74	$478.63
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $70.79 / $72.44	Facility	26	$70.79	$70.79	$72.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $426.58 / $537.03	Professional		$251.19	$426.58	$537.03
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $117.49 / $154.88	Professional	26	$72.44	$117.49	$154.88
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $309.03 / $389.05	Professional	TC	$181.97	$309.03	$389.05
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.74 / $346.74 / $346.74	Facility	26	$346.74	$346.74	$346.74
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $398.11 / $549.54	Professional		$257.04	$398.11	$549.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $112.20 / $151.36	Professional	26	$75.86	$112.20	$151.36
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $288.40 / $416.87	Professional	TC	$186.21	$288.40	$416.87
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $295.12 / $602.56	Professional		$194.98	$295.12	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $63.10 / $151.36	Professional	26	$48.98	$63.10	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $223.87 / $457.09	Professional	TC	$144.54	$223.87	$457.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $213.80 / $354.81	Professional		$186.21	$213.80	$354.81
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $60.26 / $100.00	Professional	26	$52.48	$60.26	$100.00
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $154.88 / $257.04	Professional	TC	$134.90	$154.88	$257.04