Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $60.26 / $151.36	Facility	26	$45.71	$60.26	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $186.21 / $602.56	Professional		$95.50	$186.21	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $72.44 / $239.88	Professional	26	$36.31	$72.44	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $89.13 / $354.81	Professional	TC	$56.23	$89.13	$354.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $177.83 / $229.09	Professional		$87.10	$177.83	$229.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $67.61 / $89.13	Professional	26	$30.20	$67.61	$89.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $89.13 / $162.18	Professional	TC	$74.13	$89.13	$162.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $45.71 / $66.07	Facility	26	$9.77	$45.71	$66.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $181.97 / $346.74	Professional		$104.71	$181.97	$346.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $67.61 / $120.23	Professional	26	$41.69	$67.61	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $117.49 / $218.78	Professional	TC	$66.07	$117.49	$218.78
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $79.43 / $288.40	Facility	26	$47.86	$79.43	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $213.80 / $302.00	Professional		$120.23	$213.80	$302.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $77.62 / $104.71	Professional	26	$44.67	$77.62	$104.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $138.04 / $199.53	Professional	TC	$75.86	$138.04	$199.53
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 $61.66 / $79.43 / $85.11	Facility	26	$61.66	$79.43	$85.11
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $74.13 / $91.20	Professional	26	$50.12	$74.13	$91.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $123.03 / $154.88	Professional	TC	$83.18	$123.03	$154.88
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $54.95 / $54.95	Facility	26	$54.95	$54.95	$54.95
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $245.47 / $316.23	Professional		$151.36	$245.47	$316.23
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $89.13 / $120.23	Professional	26	$54.95	$89.13	$120.23
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $158.49 / $204.17	Professional	TC	$95.50	$158.49	$204.17
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 $151.36 / $218.78 / $302.00	Professional		$151.36	$218.78	$302.00
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $81.28 / $112.20	Professional	26	$56.23	$81.28	$112.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $138.04 / $190.55	Professional	TC	$95.50	$138.04	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $123.03 / $275.42	Professional		$109.65	$123.03	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $44.67 / $104.71	Professional	26	$41.69	$44.67	$104.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $79.43 / $177.83	Professional	TC	$69.18	$79.43	$177.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $131.83 / $218.78	Professional		$114.82	$131.83	$218.78
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $47.86 / $79.43	Professional	26	$41.69	$47.86	$79.43
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $85.11 / $141.25	Professional	TC	$74.13	$85.11	$141.25