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 $128.82 / $245.47 / $891.25	Professional		$128.82	$245.47	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $61.66 / $218.78	Professional	26	$43.65	$61.66	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $147.91 / $331.13	Professional	TC	$83.18	$147.91	$331.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $181.97 / $398.11	Professional		$93.33	$181.97	$398.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $81.28 / $93.33	Professional	26	$35.48	$81.28	$93.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $165.96 / $186.21	Professional	TC	$165.96	$165.96	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $269.15 / $478.63	Professional		$134.90	$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 $190.55 / $316.23 / $426.58	Professional		$190.55	$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 / $323.59	Professional	TC	$131.83	$229.09	$323.59
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 $57.54 / $83.18 / $102.33	Professional	26	$57.54	$83.18	$102.33
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $218.78 / $302.00	Professional	TC	$147.91	$218.78	$302.00
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 / $295.12 / $398.11	Professional		$181.97	$295.12	$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 / $281.84 / $389.05	Professional		$186.21	$281.84	$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 / $416.87	Professional		$134.90	$208.93	$416.87
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 $87.10 / $100.00 / $165.96	Professional	TC	$87.10	$100.00	$165.96