Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $51.29 / $251.19	Facility	26	$31.62	$51.29	$251.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $123.03 / $478.63	Professional		$66.07	$123.03	$478.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $39.81 / $91.20	Professional	26	$25.12	$39.81	$91.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $89.13 / $239.88	Professional	TC	$42.66	$89.13	$239.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $181.97 / $218.78	Professional		$83.18	$181.97	$218.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $53.70 / $57.54	Professional	26	$43.65	$53.70	$57.54
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $151.36 / $177.83	Professional	TC	$151.36	$151.36	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $158.49 / $331.13	Professional		$87.10	$158.49	$331.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $39.81 / $79.43	Professional	26	$22.91	$39.81	$79.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $112.20 / $245.47	Professional	TC	$61.66	$112.20	$245.47
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $53.70 / $169.82	Facility	26	$30.90	$53.70	$169.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $194.98 / $275.42	Professional		$100.00	$194.98	$275.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $47.86 / $69.18	Professional	26	$26.92	$47.86	$69.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $141.25 / $204.17	Professional	TC	$74.13	$141.25	$204.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $51.29	Professional		$32.36	$33.11	$51.29
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $53.70 / $54.95	Facility	26	$44.67	$53.70	$54.95
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $46.77 / $60.26	Professional	26	$37.15	$46.77	$60.26
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $123.03 / $151.36	Professional	TC	$95.50	$123.03	$151.36
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $37.15 / $37.15	Facility	26	$37.15	$37.15	$37.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $218.78 / $295.12	Professional		$141.25	$218.78	$295.12
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $58.88 / $79.43	Professional	26	$37.15	$58.88	$79.43
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $162.18 / $218.78	Professional	TC	$102.33	$162.18	$218.78
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $158.49 / $158.49 / $158.49	Facility	26	$158.49	$158.49	$158.49
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $213.80 / $295.12	Professional		$141.25	$213.80	$295.12
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $57.54 / $75.86	Professional	26	$38.02	$57.54	$75.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $158.49 / $213.80	Professional	TC	$102.33	$158.49	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $112.20 / $269.15	Professional		$79.43	$112.20	$269.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $30.90 / $72.44	Professional	26	$22.91	$30.90	$72.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $81.28 / $194.98	Professional	TC	$54.95	$81.28	$194.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $120.23 / $194.98	Professional		$104.71	$120.23	$194.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $30.90 / $51.29	Professional	26	$26.92	$30.90	$51.29
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $87.10 / $144.54	Professional	TC	$75.86	$87.10	$144.54