Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $117.49 / $478.63	Facility	26	$57.54	$117.49	$478.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $234.42 / $588.84	Professional		$181.97	$234.42	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $54.95 / $177.83	Professional	26	$42.66	$54.95	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $169.82 / $363.08	Professional	TC	$131.83	$169.82	$363.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $380.19 / $380.19	Professional		$380.19	$380.19	$380.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $89.13 / $89.13	Professional	26	$89.13	$89.13	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $338.84 / $660.69	Professional		$194.98	$338.84	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $75.86 / $154.88	Professional	26	$43.65	$75.86	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $257.04 / $501.19	Professional	TC	$147.91	$257.04	$501.19
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $102.33 / $154.88	Facility	26	$63.10	$102.33	$154.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $407.38 / $575.44	Professional		$234.42	$407.38	$575.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $95.50 / $131.83	Professional	26	$52.48	$95.50	$131.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $316.23 / $436.52	Professional	TC	$181.97	$316.23	$436.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $102.33 / $104.71	Facility	26	$85.11	$102.33	$104.71
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $134.90 / $134.90	Professional		$134.90	$134.90	$134.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $85.11 / $104.71	Professional	26	$61.66	$85.11	$104.71
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $295.12 / $316.23	Professional	TC	$251.19	$295.12	$316.23
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $70.79 / $70.79	Facility	26	$70.79	$70.79	$70.79
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $457.09 / $602.56	Professional		$281.84	$457.09	$602.56
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $112.20 / $151.36	Professional	26	$70.79	$112.20	$151.36
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $346.74 / $457.09	Professional	TC	$213.80	$346.74	$457.09
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 $295.12 / $436.52 / $588.84	Professional		$295.12	$436.52	$588.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $109.65 / $144.54	Professional	26	$72.44	$109.65	$144.54
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $331.13 / $446.68	Professional	TC	$223.87	$331.13	$446.68
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $251.19 / $602.56	Professional		$190.55	$251.19	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $60.26 / $144.54	Professional	26	$45.71	$60.26	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $186.21 / $457.09	Professional	TC	$144.54	$186.21	$457.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $234.42 / $389.05	Professional		$204.17	$234.42	$389.05
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $58.88 / $95.50	Professional	26	$51.29	$58.88	$95.50
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $177.83 / $295.12	Professional	TC	$154.88	$177.83	$295.12