Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $112.20 / $223.87	Facility	26	$77.62	$112.20	$223.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $467.74 / $1,380.38	Professional		$208.93	$467.74	$1,380.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $141.25 / $371.54	Professional	26	$69.18	$141.25	$371.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $281.84 / $588.84	Professional	TC	$141.25	$281.84	$588.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $371.54 / $380.19	Professional		$134.90	$371.54	$380.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $120.23 / $134.90	Professional	26	$51.29	$120.23	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $426.58 / $812.83	Professional		$204.17	$426.58	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $102.33 / $204.17	Professional	26	$57.54	$102.33	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $309.03 / $660.69	Professional	TC	$138.04	$309.03	$660.69
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $134.90 / $630.96	Facility	26	$79.43	$134.90	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $512.86 / $741.31	Professional		$302.00	$512.86	$741.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $128.82 / $173.78	Professional	26	$67.61	$128.82	$173.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $371.54 / $630.96	Professional	TC	$208.93	$371.54	$630.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $83.18	Professional		$32.36	$33.11	$83.18
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $134.90 / $138.04	Facility	26	$112.20	$134.90	$138.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $128.82 / $154.88	Professional	26	$83.18	$128.82	$154.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $380.19 / $645.65	Professional	TC	$257.04	$380.19	$645.65
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $93.33 / $93.33	Facility	26	$93.33	$93.33	$93.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $467.74 / $602.56	Professional		$275.42	$467.74	$602.56
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $151.36 / $199.53	Professional	26	$93.33	$151.36	$199.53
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $309.03 / $398.11	Professional	TC	$181.97	$309.03	$398.11
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 $281.84 / $436.52 / $602.56	Professional		$281.84	$436.52	$602.56
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $147.91 / $190.55	Professional	26	$97.72	$147.91	$190.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $288.40 / $446.68	Professional	TC	$190.55	$288.40	$446.68
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $354.81 / $691.83	Professional		$194.98	$354.81	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $79.43 / $190.55	Professional	26	$60.26	$79.43	$190.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $263.03 / $501.19	Professional	TC	$131.83	$263.03	$501.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $229.09 / $380.19	Professional		$199.53	$229.09	$380.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $77.62 / $128.82	Professional	26	$67.61	$77.62	$128.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $154.88 / $257.04	Professional	TC	$134.90	$154.88	$257.04