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 / $128.82	Facility	26	$53.70	$61.66	$128.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $204.17 / $707.95	Professional		$131.83	$204.17	$707.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $54.95 / $151.36	Professional	26	$41.69	$54.95	$151.36
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $239.88 / $239.88 / $239.88	Professional	52	$239.88	$239.88	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $131.83 / $446.68	Professional	TC	$97.72	$131.83	$446.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $302.00 / $331.13	Professional		$109.65	$302.00	$331.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $77.62 / $91.20	Professional	26	$35.48	$77.62	$91.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $123.03 / $123.03	Professional	TC	$123.03	$123.03	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $263.03 / $489.78	Professional		$141.25	$263.03	$489.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $75.86 / $138.04	Professional	26	$41.69	$75.86	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $186.21 / $346.74	Professional	TC	$100.00	$186.21	$346.74
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $91.20 / $141.25	Facility	26	$53.70	$91.20	$141.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $295.12 / $416.87	Professional		$165.96	$295.12	$416.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $87.10 / $117.49	Professional	26	$46.77	$87.10	$117.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $218.78 / $302.00	Professional	TC	$123.03	$218.78	$302.00
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 $77.62 / $93.33 / $95.50	Facility	26	$77.62	$93.33	$95.50
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $77.62 / $95.50	Professional	26	$57.54	$77.62	$95.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $194.98 / $229.09	Professional	TC	$154.88	$194.98	$229.09
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $64.57 / $64.57	Facility	26	$64.57	$64.57	$64.57
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $346.74 / $457.09	Professional		$218.78	$346.74	$457.09
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $102.33 / $134.90	Professional	26	$64.57	$102.33	$134.90
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $245.47 / $323.59	Professional	TC	$154.88	$245.47	$323.59
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $229.09 / $229.09 / $229.09	Facility	26	$229.09	$229.09	$229.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $331.13 / $446.68	Professional		$218.78	$331.13	$446.68
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $100.00 / $131.83	Professional	26	$66.07	$100.00	$131.83
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $234.42 / $309.03	Professional	TC	$158.49	$234.42	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $199.53 / $416.87	Professional		$158.49	$199.53	$416.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $58.88 / $123.03	Professional	26	$44.67	$58.88	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $141.25 / $288.40	Professional	TC	$109.65	$141.25	$288.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $186.21 / $309.03	Professional		$162.18	$186.21	$309.03
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 $117.49 / $134.90 / $218.78	Professional	TC	$117.49	$134.90	$218.78