Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $131.83 / $239.88	Facility	26	$66.07	$131.83	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $309.03 / $933.25	Professional		$190.55	$309.03	$933.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $83.18 / $245.47	Professional	26	$54.95	$83.18	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $218.78 / $501.19	Professional	TC	$134.90	$218.78	$501.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $134.90 / $165.96	Professional		$134.90	$134.90	$165.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $64.57 / $107.15	Professional	26	$43.65	$64.57	$107.15
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $223.87 / $223.87	Professional	TC	$223.87	$223.87	$223.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $398.11 / $724.44	Professional		$204.17	$398.11	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $91.20 / $173.78	Professional	26	$50.12	$91.20	$173.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $302.00 / $562.34	Professional	TC	$141.25	$302.00	$562.34
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $117.49 / $489.78	Facility	26	$75.86	$117.49	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $467.74 / $616.60	Professional		$269.15	$467.74	$616.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $112.20 / $158.49	Professional	26	$64.57	$112.20	$158.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $338.84 / $512.86	Professional	TC	$199.53	$338.84	$512.86
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $89.13	Professional		$32.36	$33.11	$89.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $114.82 / $131.83	Facility	26	$95.50	$114.82	$131.83
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $269.15 / $269.15	Professional		$269.15	$269.15	$269.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $117.49 / $144.54	Professional	26	$79.43	$117.49	$144.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $354.81 / $537.03	Professional	TC	$234.42	$354.81	$537.03
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $79.43 / $79.43	Facility	26	$79.43	$79.43	$79.43
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $457.09 / $602.56	Professional		$275.42	$457.09	$602.56
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $128.82 / $169.82	Professional	26	$79.43	$128.82	$169.82
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $331.13 / $426.58	Professional	TC	$194.98	$331.13	$426.58
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 $281.84 / $436.52 / $588.84	Professional		$281.84	$436.52	$588.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $125.89 / $165.96	Professional	26	$83.18	$125.89	$165.96
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $309.03 / $426.58	Professional	TC	$204.17	$309.03	$426.58
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $316.23 / $630.96	Professional		$199.53	$316.23	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $70.79 / $169.82	Professional	26	$53.70	$70.79	$169.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $229.09 / $457.09	Professional	TC	$141.25	$229.09	$457.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $234.42 / $389.05	Professional		$204.17	$234.42	$389.05
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $67.61 / $109.65	Professional	26	$57.54	$67.61	$109.65
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $165.96 / $275.42	Professional	TC	$144.54	$165.96	$275.42