Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $186.21 / $288.40	Facility	26	$138.04	$186.21	$288.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $239.88 / $812.83	Professional		$169.82	$239.88	$812.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $128.82 / $501.19	Professional	26	$95.50	$128.82	$501.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $85.11 / $154.88	Professional	TC	$67.61	$85.11	$154.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $309.03 / $380.19	Professional		$158.49	$309.03	$380.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $194.98 / $218.78	Professional	26	$147.91	$194.98	$218.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $316.23 / $537.03	Professional		$190.55	$316.23	$537.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $173.78 / $309.03	Professional	26	$114.82	$173.78	$309.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $134.90 / $223.87	Professional	TC	$85.11	$134.90	$223.87
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $151.36 / $263.03	Facility	26	$91.20	$151.36	$263.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $245.47 / $436.52	Professional		$162.18	$245.47	$436.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $138.04 / $234.42	Professional	26	$89.13	$138.04	$234.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $109.65 / $190.55	Professional	TC	$72.44	$109.65	$190.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $107.15	Professional		$32.36	$33.11	$107.15
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $204.17 / $208.93	Facility	26	$169.82	$204.17	$208.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $169.82 / $218.78	Professional	26	$134.90	$169.82	$218.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $128.82 / $177.83	Professional	TC	$102.33	$128.82	$177.83
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $141.25 / $141.25	Facility	26	$141.25	$141.25	$141.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $354.81 / $501.19	Professional		$239.88	$354.81	$501.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $213.80 / $302.00	Professional	26	$141.25	$213.80	$302.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $147.91 / $204.17	Professional	TC	$97.72	$147.91	$204.17
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $512.86 / $512.86 / $512.86	Facility	26	$512.86	$512.86	$512.86
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $338.84 / $446.68	Professional		$218.78	$338.84	$446.68
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $199.53 / $263.03	Professional	26	$125.89	$199.53	$263.03
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $141.25 / $186.21	Professional	TC	$89.13	$141.25	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $295.12 / $512.86	Professional		$190.55	$295.12	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $165.96 / $302.00	Professional	26	$112.20	$165.96	$302.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $125.89 / $218.78	Professional	TC	$81.28	$125.89	$218.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $213.80 / $363.08	Professional		$190.55	$213.80	$363.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $117.49 / $204.17	Professional	26	$109.65	$117.49	$204.17
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $95.50 / $158.49	Professional	TC	$83.18	$95.50	$158.49