Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $154.88 / $251.19	Facility	26	$83.18	$154.88	$251.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $478.63 / $1,698.24	Professional		$269.15	$478.63	$1,698.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $125.89 / $338.84	Professional	26	$70.79	$125.89	$338.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $338.84 / $645.65	Professional	TC	$199.53	$338.84	$645.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $181.97 / $512.86	Professional		$181.97	$181.97	$512.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $524.81 / $891.25	Professional		$275.42	$524.81	$891.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $102.33 / $204.17	Professional	26	$58.88	$102.33	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $416.87 / $724.44	Professional	TC	$204.17	$416.87	$724.44
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $138.04 / $691.83	Facility	26	$79.43	$138.04	$691.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $602.56 / $776.25	Professional		$346.74	$602.56	$776.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $128.82 / $173.78	Professional	26	$67.61	$128.82	$173.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $467.74 / $630.96	Professional	TC	$275.42	$467.74	$630.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $125.89	Professional		$32.36	$33.11	$125.89
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $138.04 / $141.25	Facility	26	$114.82	$138.04	$141.25
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $245.47 / $245.47	Professional		$245.47	$245.47	$245.47
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $125.89 / $154.88	Professional	26	$85.11	$125.89	$154.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $436.52 / $645.65	Professional	TC	$281.84	$436.52	$645.65
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $93.33 / $95.50	Facility	26	$93.33	$93.33	$95.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $616.60 / $794.33	Professional		$371.54	$616.60	$794.33
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $147.91 / $199.53	Professional	26	$95.50	$147.91	$199.53
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $467.74 / $602.56	Professional	TC	$275.42	$467.74	$602.56
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 $389.05 / $588.84 / $776.25	Professional		$389.05	$588.84	$776.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $147.91 / $194.98	Professional	26	$97.72	$147.91	$194.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $446.68 / $588.84	Professional	TC	$295.12	$446.68	$588.84
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $398.11 / $831.76	Professional		$269.15	$398.11	$831.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $79.43 / $194.98	Professional	26	$60.26	$79.43	$194.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $323.59 / $645.65	Professional	TC	$204.17	$323.59	$645.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $309.03 / $512.86	Professional		$269.15	$309.03	$512.86
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $77.62 / $128.82	Professional	26	$67.61	$77.62	$128.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $234.42 / $380.19	Professional	TC	$204.17	$234.42	$380.19