Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $61.66 / $138.04	Facility	26	$53.70	$61.66	$138.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $218.78 / $630.96	Professional		$109.65	$218.78	$630.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $81.28 / $239.88	Professional	26	$42.66	$81.28	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $95.50 / $363.08	Professional	TC	$58.88	$95.50	$363.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $173.78 / $245.47	Professional		$97.72	$173.78	$245.47
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $77.62 / $87.10	Professional	26	$35.48	$77.62	$87.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $109.65 / $151.36	Professional	TC	$74.13	$109.65	$151.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $204.17 / $371.54	Professional		$120.23	$204.17	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $77.62 / $138.04	Professional	26	$47.86	$77.62	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $125.89 / $223.87	Professional	TC	$72.44	$125.89	$223.87
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $93.33 / $323.59	Facility	26	$54.95	$93.33	$323.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $229.09 / $323.59	Professional		$141.25	$229.09	$323.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $89.13 / $120.23	Professional	26	$52.48	$89.13	$120.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $141.25 / $204.17	Professional	TC	$89.13	$141.25	$204.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $64.57	Professional		$32.36	$33.11	$64.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $93.33 / $95.50	Facility	26	$75.86	$93.33	$95.50
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $81.28 / $100.00	Professional	26	$56.23	$81.28	$100.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $123.03 / $154.88	Professional	TC	$85.11	$123.03	$154.88
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $63.10 / $63.10	Facility	26	$63.10	$63.10	$63.10
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $263.03 / $338.84	Professional		$162.18	$263.03	$338.84
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $104.71 / $144.54	Professional	26	$63.10	$104.71	$144.54
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $158.49 / $208.93	Professional	TC	$97.72	$158.49	$208.93
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $234.42 / $323.59	Professional		$162.18	$234.42	$323.59
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $95.50 / $128.82	Professional	26	$64.57	$95.50	$128.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $141.25 / $194.98	Professional	TC	$97.72	$141.25	$194.98
United Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $131.83 / $302.00	Professional		$120.23	$131.83	$302.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $52.48 / $120.23	Professional	26	$47.86	$52.48	$120.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $81.28 / $181.97	Professional	TC	$74.13	$81.28	$181.97
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $138.04 / $229.09	Professional		$120.23	$138.04	$229.09
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $53.70 / $89.13	Professional	26	$46.77	$53.70	$89.13
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $85.11 / $141.25	Professional	TC	$74.13	$85.11	$141.25