Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $114.82 / $204.17	Facility	26	$58.88	$114.82	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $218.78 / $1,258.93	Professional		$117.49	$218.78	$1,258.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $218.78 / $954.99	Professional	26	$57.54	$218.78	$954.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $100.00 / $389.05	Professional	TC	$56.23	$100.00	$389.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $128.82 / $331.13	Professional		$100.00	$128.82	$331.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $66.07 / $125.89	Professional	26	$48.98	$66.07	$125.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $56.23 / $56.23	Professional	TC	$56.23	$56.23	$56.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $263.03 / $398.11	Professional		$154.88	$263.03	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $120.23 / $181.97	Professional	26	$72.44	$120.23	$181.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $147.91 / $218.78	Professional	TC	$83.18	$147.91	$218.78
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $134.90 / $1,584.89	Facility	26	$77.62	$134.90	$1,584.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $281.84 / $363.08	Professional		$162.18	$281.84	$363.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $128.82 / $162.18	Professional	26	$77.62	$128.82	$162.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $151.36 / $199.53	Professional	TC	$85.11	$151.36	$199.53
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 $95.50 / $117.49 / $120.23	Facility	26	$95.50	$117.49	$120.23
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $102.33 / $134.90	Professional	26	$69.18	$102.33	$134.90
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $128.82 / $165.96	Professional	TC	$81.28	$128.82	$165.96
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $79.43 / $83.18	Facility	26	$79.43	$79.43	$83.18
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $281.84 / $371.54	Professional		$173.78	$281.84	$371.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $134.90 / $177.83	Professional	26	$83.18	$134.90	$177.83
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $147.91 / $190.55	Professional	TC	$89.13	$147.91	$190.55
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $660.69 / $660.69 / $660.69	Facility	26	$660.69	$660.69	$660.69
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $257.04 / $354.81	Professional		$169.82	$257.04	$354.81
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $125.89 / $169.82	Professional	26	$81.28	$125.89	$169.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $134.90 / $181.97	Professional	TC	$87.10	$134.90	$181.97
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $186.21 / $338.84	Professional		$128.82	$186.21	$338.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $77.62 / $154.88	Professional	26	$54.95	$77.62	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $102.33 / $177.83	Professional	TC	$67.61	$102.33	$177.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $177.83 / $251.19	Professional		$131.83	$177.83	$251.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $83.18 / $117.49	Professional	26	$61.66	$83.18	$117.49
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $93.33 / $131.83	Professional	TC	$69.18	$93.33	$131.83