Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $104.71 / $204.17	Facility	26	$63.10	$104.71	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $199.53 / $562.34	Professional		$141.25	$199.53	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $83.18 / $208.93	Professional	26	$48.98	$83.18	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $138.04 / $346.74	Professional	TC	$95.50	$138.04	$346.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $331.13 / $331.13	Professional		$331.13	$331.13	$331.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $91.20 / $95.50	Professional	26	$48.98	$91.20	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $371.54 / $575.44	Professional		$234.42	$371.54	$575.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $114.82 / $181.97	Professional	26	$74.13	$114.82	$181.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $251.19 / $398.11	Professional	TC	$158.49	$251.19	$398.11
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $138.04 / $2,344.23	Facility	26	$89.13	$138.04	$2,344.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $398.11 / $512.86	Professional		$275.42	$398.11	$512.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $128.82 / $158.49	Professional	26	$89.13	$128.82	$158.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $275.42 / $354.81	Professional	TC	$186.21	$275.42	$354.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $109.65 / $112.20	Facility	26	$91.20	$109.65	$112.20
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $100.00 / $117.49	Professional	26	$67.61	$100.00	$117.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $199.53 / $239.88	Professional	TC	$138.04	$199.53	$239.88
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $75.86 / $75.86	Facility	26	$75.86	$75.86	$75.86
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $398.11 / $512.86	Professional		$239.88	$398.11	$512.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $125.89 / $162.18	Professional	26	$75.86	$125.89	$162.18
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $269.15 / $346.74	Professional	TC	$165.96	$269.15	$346.74
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $954.99 / $954.99 / $954.99	Facility	26	$954.99	$954.99	$954.99
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $371.54 / $501.19	Professional		$239.88	$371.54	$501.19
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $117.49 / $158.49	Professional	26	$75.86	$117.49	$158.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $251.19 / $338.84	Professional	TC	$162.18	$251.19	$338.84
United Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $186.21 / $489.78	Professional		$151.36	$186.21	$489.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $60.26 / $158.49	Professional	26	$48.98	$60.26	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $128.82 / $331.13	Professional	TC	$102.33	$128.82	$331.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $239.88 / $338.84	Professional		$204.17	$239.88	$338.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $74.13 / $104.71	Professional	26	$63.10	$74.13	$104.71
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $165.96 / $234.42	Professional	TC	$141.25	$165.96	$234.42