Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $89.13 / $154.88	Facility	26	$61.66	$89.13	$154.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $223.87 / $524.81	Professional		$114.82	$223.87	$524.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $85.11 / $288.40	Professional	26	$51.29	$85.11	$288.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $190.55 / $371.54	Professional	TC	$114.82	$190.55	$371.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $89.13 / $100.00	Professional	26	$40.74	$89.13	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $331.13 / $588.84	Professional		$173.78	$331.13	$588.84
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 $117.49 / $239.88 / $446.68	Professional	TC	$117.49	$239.88	$446.68
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 $239.88 / $389.05 / $524.81	Professional		$239.88	$389.05	$524.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $102.33 / $138.04	Professional	26	$53.70	$102.33	$138.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $295.12 / $398.11	Professional	TC	$173.78	$295.12	$398.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $75.86	Professional		$32.36	$33.11	$75.86
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 $199.53 / $199.53 / $257.04	Professional		$199.53	$199.53	$257.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $100.00 / $114.82	Professional	26	$66.07	$100.00	$114.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $288.40 / $371.54	Professional	TC	$186.21	$288.40	$371.54
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 $234.42 / $389.05 / $489.78	Professional		$234.42	$389.05	$489.78
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 $158.49 / $269.15 / $346.74	Professional	TC	$158.49	$269.15	$346.74
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 $239.88 / $371.54 / $501.19	Professional		$239.88	$371.54	$501.19
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 $162.18 / $251.19 / $346.74	Professional	TC	$162.18	$251.19	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $251.19 / $524.81	Professional		$165.96	$251.19	$524.81
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 $117.49 / $186.21 / $371.54	Professional	TC	$117.49	$186.21	$371.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $199.53 / $331.13	Professional		$173.78	$199.53	$331.13
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 $117.49 / $134.90 / $223.87	Professional	TC	$117.49	$134.90	$223.87