Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $181.97 / $229.09	Facility	26	$112.20	$181.97	$229.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $323.59 / $1,148.15	Professional		$223.87	$323.59	$1,148.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $120.23 / $398.11	Professional	26	$77.62	$120.23	$398.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $177.83 / $426.58	Professional	TC	$138.04	$177.83	$426.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $446.68 / $630.96	Professional		$213.80	$446.68	$630.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $134.90 / $158.49	Professional	26	$70.79	$134.90	$158.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $407.38 / $741.31	Professional		$263.03	$407.38	$741.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $144.54 / $251.19	Professional	26	$91.20	$144.54	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $263.03 / $501.19	Professional	TC	$165.96	$263.03	$501.19
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $162.18 / $1,513.56	Facility	26	$100.00	$162.18	$1,513.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $436.52 / $645.65	Professional		$269.15	$436.52	$645.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $154.88 / $208.93	Professional	26	$95.50	$154.88	$208.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $281.84 / $436.52	Professional	TC	$173.78	$281.84	$436.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $100.00	Professional		$32.36	$33.11	$100.00
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $131.83 / $162.18 / $162.18	Facility	26	$131.83	$162.18	$162.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $144.54 / $177.83	Professional	26	$102.33	$144.54	$177.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $269.15 / $354.81	Professional	TC	$213.80	$269.15	$354.81
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $109.65	Facility	26	$109.65	$109.65	$109.65
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $489.78 / $660.69	Professional		$316.23	$489.78	$660.69
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $177.83 / $239.88	Professional	26	$109.65	$177.83	$239.88
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $331.13 / $446.68	Professional	TC	$208.93	$331.13	$446.68
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $933.25 / $933.25 / $933.25	Facility	26	$933.25	$933.25	$933.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $457.09 / $588.84	Professional		$323.59	$457.09	$588.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $158.49 / $208.93	Professional	26	$112.20	$158.49	$208.93
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $295.12 / $389.05	Professional	TC	$208.93	$295.12	$389.05
United Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $354.81 / $602.56	Professional		$239.88	$354.81	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $131.83 / $218.78	Professional	26	$87.10	$131.83	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $229.09 / $398.11	Professional	TC	$151.36	$229.09	$398.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $281.84 / $457.09	Professional		$239.88	$281.84	$457.09
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $95.50 / $158.49	Professional	26	$83.18	$95.50	$158.49
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $181.97 / $302.00	Professional	TC	$158.49	$181.97	$302.00