Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $85.11 / $114.82	Facility	26	$51.29	$85.11	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $120.23 / $281.84	Professional		$79.43	$120.23	$281.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $46.77 / $181.97	Professional	26	$16.98	$46.77	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $70.79 / $194.98	Professional	TC	$43.65	$70.79	$194.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $33.88 / $74.13	Professional	26	$33.88	$33.88	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $186.21 / $371.54	Professional		$85.11	$186.21	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $50.12 / $125.89	Professional	26	$18.20	$50.12	$125.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $123.03 / $346.74	Professional	TC	$53.70	$123.03	$346.74
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $35.48 / $104.71	Facility	26	$19.95	$35.48	$104.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $190.55 / $275.42	Professional		$95.50	$190.55	$275.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $35.48 / $104.71	Professional	26	$16.60	$35.48	$104.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $131.83 / $218.78	Professional	TC	$74.13	$131.83	$218.78
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 $28.18 / $87.10 / $93.33	Facility	26	$28.18	$87.10	$93.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $33.88 / $91.20	Professional	26	$22.91	$33.88	$91.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $128.82 / $239.88	Professional	TC	$83.18	$128.82	$239.88
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $61.66 / $61.66	Facility	26	$61.66	$61.66	$61.66
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $218.78 / $288.40	Professional		$131.83	$218.78	$288.40
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $100.00 / $131.83	Professional	26	$61.66	$100.00	$131.83
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $120.23 / $169.82	Professional	TC	$69.18	$120.23	$169.82
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $190.55 / $269.15	Professional		$134.90	$190.55	$269.15
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $91.20 / $128.82	Professional	26	$37.15	$91.20	$128.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $109.65 / $147.91	Professional	TC	$72.44	$109.65	$147.91
United Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $141.25 / $354.81	Professional		$95.50	$141.25	$354.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $50.12 / $117.49	Professional	26	$17.78	$50.12	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $85.11 / $208.93	Professional	TC	$56.23	$85.11	$208.93
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $112.20 / $186.21	Professional		$97.72	$112.20	$186.21
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $51.29 / $85.11	Professional	26	$44.67	$51.29	$85.11
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $61.66 / $102.33	Professional	TC	$53.70	$61.66	$102.33