Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $95.50 / $120.23	Facility	26	$60.26	$95.50	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $162.18 / $602.56	Professional		$125.89	$162.18	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $51.29 / $165.96	Professional	26	$38.90	$51.29	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $112.20 / $263.03	Professional	TC	$81.28	$112.20	$263.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $75.86 / $89.13	Professional	26	$75.86	$75.86	$89.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $48.98 / $70.79	Facility	26	$10.47	$48.98	$70.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $239.88 / $446.68	Professional		$147.91	$239.88	$446.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $75.86 / $134.90	Professional	26	$47.86	$75.86	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $165.96 / $309.03	Professional	TC	$102.33	$165.96	$309.03
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $85.11 / $691.83	Facility	26	$52.48	$85.11	$691.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $257.04 / $363.08	Professional		$141.25	$257.04	$363.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $81.28 / $109.65	Professional	26	$50.12	$81.28	$109.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $181.97 / $257.04	Professional	TC	$89.13	$181.97	$257.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $61.66	Professional		$32.36	$33.11	$61.66
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $85.11 / $89.13	Facility	26	$69.18	$85.11	$89.13
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Professional		$125.89	$125.89	$125.89
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $75.86 / $91.20	Professional	26	$51.29	$75.86	$91.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $144.54 / $204.17	Professional	TC	$107.15	$144.54	$204.17
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $57.54 / $58.88	Facility	26	$57.54	$57.54	$58.88
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $302.00 / $389.05	Professional		$186.21	$302.00	$389.05
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $93.33 / $128.82	Professional	26	$57.54	$93.33	$128.82
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $213.80 / $281.84	Professional	TC	$128.82	$213.80	$281.84
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	26	$446.68	$446.68	$446.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $269.15 / $346.74	Professional		$190.55	$269.15	$346.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $83.18 / $109.65	Professional	26	$60.26	$83.18	$109.65
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $186.21 / $239.88	Professional	TC	$131.83	$186.21	$239.88
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $213.80 / $354.81	Professional		$144.54	$213.80	$354.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $67.61 / $117.49	Professional	26	$45.71	$67.61	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $147.91 / $245.47	Professional	TC	$95.50	$147.91	$245.47
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $165.96 / $275.42	Professional		$144.54	$165.96	$275.42
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $50.12 / $83.18	Professional	26	$43.65	$50.12	$83.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $114.82 / $190.55	Professional	TC	$100.00	$114.82	$190.55