Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $72.44 / $154.88	Facility	26	$61.66	$72.44	$154.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $302.00 / $1,122.02	Professional		$213.80	$302.00	$1,122.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $83.18 / $213.80	Professional	26	$52.48	$83.18	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $218.78 / $446.68	Professional	TC	$162.18	$218.78	$446.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $436.52 / $436.52	Professional		$436.52	$436.52	$436.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $93.33 / $95.50	Professional	26	$40.74	$93.33	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $380.19 / $724.44	Professional		$218.78	$380.19	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $81.28 / $162.18	Professional	26	$45.71	$81.28	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $302.00 / $562.34	Professional	TC	$162.18	$302.00	$562.34
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $107.15 / $489.78	Facility	26	$63.10	$107.15	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $457.09 / $645.65	Professional		$257.04	$457.09	$645.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $100.00 / $138.04	Professional	26	$53.70	$100.00	$138.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $354.81 / $501.19	Professional	TC	$204.17	$354.81	$501.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $112.20	Professional		$32.36	$33.11	$112.20
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $107.15 / $112.20	Facility	26	$89.13	$107.15	$112.20
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $234.42 / $257.04	Professional		$234.42	$234.42	$257.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $95.50 / $123.03	Professional	26	$66.07	$95.50	$123.03
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $316.23 / $446.68	Professional	TC	$204.17	$316.23	$446.68
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $74.13 / $74.13	Facility	26	$74.13	$74.13	$74.13
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $512.86 / $676.08	Professional		$323.59	$512.86	$676.08
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $117.49 / $158.49	Professional	26	$74.13	$117.49	$158.49
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $407.38 / $524.81	Professional	TC	$245.47	$407.38	$524.81
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 $338.84 / $501.19 / $676.08	Professional		$338.84	$501.19	$676.08
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $114.82 / $151.36	Professional	26	$77.62	$114.82	$151.36
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $380.19 / $524.81	Professional	TC	$263.03	$380.19	$524.81
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $281.84 / $645.65	Professional		$204.17	$281.84	$645.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $61.66 / $144.54	Professional	26	$47.86	$61.66	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $223.87 / $489.78	Professional	TC	$154.88	$223.87	$489.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $269.15 / $446.68	Professional		$234.42	$269.15	$446.68
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $61.66 / $102.33	Professional	26	$53.70	$61.66	$102.33
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $208.93 / $346.74	Professional	TC	$181.97	$208.93	$346.74