Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $70.79 / $134.90	Facility	26	$53.70	$70.79	$134.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $229.09 / $870.96	Professional		$131.83	$229.09	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $63.10 / $208.93	Professional	26	$43.65	$63.10	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $147.91 / $323.59	Professional	TC	$83.18	$147.91	$323.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Professional		$93.33	$93.33	$93.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $77.62 / $125.89	Professional	26	$34.67	$77.62	$125.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $158.49 / $158.49	Professional	TC	$158.49	$158.49	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $269.15 / $478.63	Professional		$138.04	$269.15	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $70.79 / $138.04	Professional	26	$39.81	$70.79	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $186.21 / $371.54	Professional	TC	$89.13	$186.21	$371.54
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $93.33 / $288.40	Facility	26	$60.26	$93.33	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $316.23 / $426.58	Professional		$194.98	$316.23	$426.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $89.13 / $117.49	Professional	26	$52.48	$89.13	$117.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $229.09 / $331.13	Professional	TC	$131.83	$229.09	$331.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $57.54	Professional		$32.36	$33.11	$57.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $93.33 / $95.50	Facility	26	$77.62	$93.33	$95.50
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $89.13 / $107.15	Professional	26	$64.57	$89.13	$107.15
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $223.87 / $338.84	Professional	TC	$158.49	$223.87	$338.84
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $64.57 / $64.57	Facility	26	$64.57	$64.57	$64.57
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $302.00 / $398.11	Professional		$181.97	$302.00	$398.11
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $102.33 / $134.90	Professional	26	$64.57	$102.33	$134.90
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $199.53 / $257.04	Professional	TC	$117.49	$199.53	$257.04
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 $186.21 / $288.40 / $389.05	Professional		$186.21	$288.40	$389.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $100.00 / $131.83	Professional	26	$66.07	$100.00	$131.83
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $186.21 / $269.15	Professional	TC	$120.23	$186.21	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $208.93 / $426.58	Professional		$134.90	$208.93	$426.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $53.70 / $125.89	Professional	26	$41.69	$53.70	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $147.91 / $295.12	Professional	TC	$91.20	$147.91	$295.12
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $154.88 / $257.04	Professional		$134.90	$154.88	$257.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $53.70 / $89.13	Professional	26	$46.77	$53.70	$89.13
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $102.33 / $165.96	Professional	TC	$89.13	$102.33	$165.96