Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $107.15 / $234.42	Facility	26	$93.33	$107.15	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $257.04 / $912.01	Professional		$177.83	$257.04	$912.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $91.20 / $288.40	Professional	26	$72.44	$91.20	$288.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $138.04 / $316.23	Professional	TC	$100.00	$138.04	$316.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $354.81 / $524.81	Professional		$128.82	$354.81	$524.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $141.25 / $162.18	Professional	26	$87.10	$141.25	$162.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $120.23 / $229.09	Professional	TC	$117.49	$120.23	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $309.03 / $602.56	Professional		$177.83	$309.03	$602.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $117.49 / $239.88	Professional	26	$69.18	$117.49	$239.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $181.97 / $354.81	Professional	TC	$97.72	$181.97	$354.81
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $162.18 / $630.96	Facility	26	$95.50	$162.18	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $380.19 / $501.19	Professional		$213.80	$380.19	$501.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $154.88 / $208.93	Professional	26	$81.28	$154.88	$208.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $223.87 / $302.00	Professional	TC	$131.83	$223.87	$302.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $70.79	Professional		$32.36	$33.11	$70.79
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $134.90 / $162.18 / $165.96	Facility	26	$134.90	$162.18	$165.96
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $147.91 / $181.97	Professional	26	$100.00	$147.91	$181.97
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $204.17 / $251.19	Professional	TC	$144.54	$204.17	$251.19
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $112.20 / $112.20	Facility	26	$112.20	$112.20	$112.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $426.58 / $562.34	Professional		$257.04	$426.58	$562.34
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $181.97 / $239.88	Professional	26	$112.20	$181.97	$239.88
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $239.88 / $316.23	Professional	TC	$144.54	$239.88	$316.23
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	26	$446.68	$446.68	$446.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $398.11 / $524.81	Professional		$263.03	$398.11	$524.81
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $173.78 / $229.09	Professional	26	$114.82	$173.78	$229.09
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $229.09 / $309.03	Professional	TC	$147.91	$229.09	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $223.87 / $512.86	Professional		$169.82	$223.87	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $93.33 / $218.78	Professional	26	$70.79	$93.33	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $125.89 / $302.00	Professional	TC	$95.50	$125.89	$302.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $218.78 / $363.08	Professional		$190.55	$218.78	$363.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $93.33 / $154.88	Professional	26	$81.28	$93.33	$154.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $125.89 / $204.17	Professional	TC	$109.65	$125.89	$204.17