Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $87.10 / $151.36	Facility	26	$60.26	$87.10	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $275.42 / $724.44	Professional		$151.36	$275.42	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $102.33 / $257.04	Professional	26	$52.48	$102.33	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $177.83 / $436.52	Professional	TC	$100.00	$177.83	$436.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $257.04 / $257.04	Professional		$257.04	$257.04	$257.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $85.11 / $97.72	Professional	26	$39.81	$85.11	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $302.00 / $562.34	Professional		$151.36	$302.00	$562.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $83.18 / $158.49	Professional	26	$44.67	$83.18	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $213.80 / $416.87	Professional	TC	$102.33	$213.80	$416.87
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $104.71 / $489.78	Facility	26	$69.18	$104.71	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $346.74 / $501.19	Professional		$204.17	$346.74	$501.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $104.71 / $138.04	Professional	26	$58.88	$104.71	$138.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $239.88 / $398.11	Professional	TC	$134.90	$239.88	$398.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $67.61	Professional		$32.36	$33.11	$67.61
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $104.71 / $120.23	Facility	26	$87.10	$104.71	$120.23
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $204.17 / $229.09	Professional		$165.96	$204.17	$229.09
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $102.33 / $123.03	Professional	26	$66.07	$102.33	$123.03
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $218.78 / $426.58	Professional	TC	$131.83	$218.78	$426.58
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 $213.80 / $354.81 / $467.74	Professional		$213.80	$354.81	$467.74
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $114.82 / $154.88	Professional	26	$72.44	$114.82	$154.88
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $234.42 / $302.00	Professional	TC	$141.25	$234.42	$302.00
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 $218.78 / $331.13 / $457.09	Professional		$218.78	$331.13	$457.09
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $112.20 / $147.91	Professional	26	$74.13	$112.20	$147.91
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $223.87 / $331.13	Professional	TC	$144.54	$223.87	$331.13
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $245.47 / $467.74	Professional		$144.54	$245.47	$467.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $63.10 / $144.54	Professional	26	$48.98	$63.10	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $169.82 / $316.23	Professional	TC	$95.50	$169.82	$316.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $181.97 / $302.00	Professional		$158.49	$181.97	$302.00
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 $104.71 / $120.23 / $199.53	Professional	TC	$104.71	$120.23	$199.53