Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $134.90 / $169.82	Facility	26	$91.20	$134.90	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $123.03 / $380.19	Professional		$93.33	$123.03	$380.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $77.62 / $281.84	Professional	26	$56.23	$77.62	$281.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $47.86 / $107.15	Professional	TC	$30.20	$47.86	$107.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $186.21 / $223.87	Professional		$123.03	$186.21	$223.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $72.44 / $72.44	Professional	26	$72.44	$72.44	$72.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $165.96 / $354.81	Professional		$107.15	$165.96	$354.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $104.71 / $199.53	Professional	26	$66.07	$104.71	$199.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $61.66 / $154.88	Professional	TC	$29.51	$61.66	$154.88
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $83.18 / $141.25	Facility	26	$56.23	$83.18	$141.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $114.82 / $234.42	Professional		$83.18	$114.82	$234.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $79.43 / $138.04	Professional	26	$56.23	$79.43	$138.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $34.67 / $102.33	Professional	TC	$25.12	$34.67	$102.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $33.11 / $67.61	Professional		$30.90	$33.11	$67.61
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $117.49 / $120.23	Facility	26	$97.72	$117.49	$120.23
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $104.71 / $131.83	Professional	26	$72.44	$104.71	$131.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $48.98 / $81.28	Professional	TC	$36.31	$48.98	$81.28
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $81.28 / $81.28	Facility	26	$81.28	$81.28	$81.28
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $213.80 / $302.00	Professional		$144.54	$213.80	$302.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $120.23 / $173.78	Professional	26	$81.28	$120.23	$173.78
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $93.33 / $128.82	Professional	TC	$63.10	$93.33	$128.82
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $72.44 / $72.44	Facility	26	$72.44	$72.44	$72.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $190.55 / $275.42	Professional		$147.91	$190.55	$275.42
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $112.20 / $158.49	Professional	26	$83.18	$112.20	$158.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $77.62 / $120.23	Professional	TC	$48.98	$77.62	$120.23
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $147.91 / $275.42	Professional		$104.71	$147.91	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $97.72 / $169.82	Professional	26	$66.07	$97.72	$169.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $52.48 / $117.49	Professional	TC	$34.67	$52.48	$117.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $120.23 / $204.17	Professional		$107.15	$120.23	$204.17
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $64.57 / $114.82	Professional	26	$60.26	$64.57	$114.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $54.95 / $89.13	Professional	TC	$47.86	$54.95	$89.13