Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $56.23 / $104.71	Facility	26	$47.86	$56.23	$104.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $257.04 / $870.96	Professional		$177.83	$257.04	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $45.71 / $125.89	Professional	26	$33.88	$45.71	$125.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $186.21 / $524.81	Professional	TC	$138.04	$186.21	$524.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $346.74 / $398.11	Professional		$134.90	$346.74	$398.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $66.07 / $75.86	Professional	26	$30.90	$66.07	$75.86
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $288.40 / $288.40	Professional	TC	$288.40	$288.40	$288.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $42.66 / $61.66	Facility	26	$9.12	$42.66	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $346.74 / $616.60	Professional		$213.80	$346.74	$616.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $57.54 / $117.49	Professional	26	$34.67	$57.54	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $281.84 / $512.86	Professional	TC	$173.78	$281.84	$512.86
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $74.13 / $630.96	Facility	26	$33.11	$74.13	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $398.11 / $537.03	Professional		$251.19	$398.11	$537.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $69.18 / $95.50	Professional	26	$33.88	$69.18	$95.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $331.13 / $436.52	Professional	TC	$199.53	$331.13	$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 $56.23 / $74.13 / $75.86	Facility	26	$56.23	$74.13	$75.86
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 $40.74 / $57.54 / $83.18	Professional	26	$40.74	$57.54	$83.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $295.12 / $389.05	Professional	TC	$208.93	$295.12	$389.05
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Facility	26	$51.29	$51.29	$51.29
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $407.38 / $549.54	Professional		$263.03	$407.38	$549.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $81.28 / $112.20	Professional	26	$51.29	$81.28	$112.20
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $338.84 / $446.68	Professional	TC	$208.93	$338.84	$446.68
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 $269.15 / $371.54 / $489.78	Professional		$269.15	$371.54	$489.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $74.13 / $95.50	Professional	26	$50.12	$74.13	$95.50
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $302.00 / $389.05	Professional	TC	$213.80	$302.00	$389.05
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $309.03 / $537.03	Professional		$204.17	$309.03	$537.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $54.95 / $104.71	Professional	26	$37.15	$54.95	$104.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $257.04 / $426.58	Professional	TC	$162.18	$257.04	$426.58
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $229.09 / $371.54	Professional		$194.98	$229.09	$371.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $43.65 / $70.79	Professional	26	$38.02	$43.65	$70.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $181.97 / $302.00	Professional	TC	$158.49	$181.97	$302.00