Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $100.00 / $158.49	Facility	26	$63.10	$100.00	$158.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $229.09 / $794.33	Professional		$138.04	$229.09	$794.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $77.62 / $218.78	Professional	26	$51.29	$77.62	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $134.90 / $338.84	Professional	TC	$81.28	$134.90	$338.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $263.03	Professional		$97.72	$97.72	$263.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $77.62 / $104.71	Professional	26	$41.69	$77.62	$104.71
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 $47.86 / $83.18 / $165.96	Professional	26	$47.86	$83.18	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $165.96 / $331.13	Professional	TC	$83.18	$165.96	$331.13
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $109.65 / $288.40	Facility	26	$64.57	$109.65	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $302.00 / $398.11	Professional		$165.96	$302.00	$398.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $102.33 / $141.25	Professional	26	$54.95	$102.33	$141.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $190.55 / $263.03	Professional	TC	$109.65	$190.55	$263.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $56.23	Professional		$32.36	$33.11	$56.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $109.65 / $114.82	Facility	26	$91.20	$109.65	$114.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $97.72 / $123.03	Professional	26	$67.61	$97.72	$123.03
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $169.82 / $316.23	Professional	TC	$107.15	$169.82	$316.23
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $75.86 / $75.86	Facility	26	$75.86	$75.86	$75.86
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $316.23 / $416.87	Professional		$190.55	$316.23	$416.87
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $120.23 / $162.18	Professional	26	$75.86	$120.23	$162.18
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $190.55 / $245.47	Professional	TC	$114.82	$190.55	$245.47
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 $194.98 / $295.12 / $398.11	Professional		$194.98	$295.12	$398.11
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $120.23 / $158.49	Professional	26	$79.43	$120.23	$158.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $181.97 / $245.47	Professional	TC	$117.49	$181.97	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $204.17 / $407.38	Professional		$128.82	$204.17	$407.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $63.10 / $151.36	Professional	26	$48.98	$63.10	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $125.89 / $245.47	Professional	TC	$77.62	$125.89	$245.47
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $162.18 / $269.15	Professional		$141.25	$162.18	$269.15
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $63.10 / $104.71	Professional	26	$54.95	$63.10	$104.71
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $97.72 / $162.18	Professional	TC	$85.11	$97.72	$162.18