Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $91.20 / $169.82	Facility	26	$67.61	$91.20	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $281.84 / $1,071.52	Professional		$169.82	$281.84	$1,071.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $85.11 / $263.03	Professional	26	$54.95	$85.11	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $181.97 / $371.54	Professional	TC	$114.82	$181.97	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $123.03 / $331.13	Professional		$123.03	$123.03	$331.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $97.72 / $158.49	Professional	26	$44.67	$97.72	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $338.84 / $588.84	Professional		$173.78	$338.84	$588.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $89.13 / $177.83	Professional	26	$51.29	$89.13	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $234.42 / $446.68	Professional	TC	$117.49	$234.42	$446.68
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $117.49 / $489.78	Facility	26	$69.18	$117.49	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $380.19 / $501.19	Professional		$204.17	$380.19	$501.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $109.65 / $151.36	Professional	26	$58.88	$109.65	$151.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $263.03 / $371.54	Professional	TC	$147.91	$263.03	$371.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $75.86	Professional		$32.36	$33.11	$75.86
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $117.49 / $123.03	Facility	26	$97.72	$117.49	$123.03
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $138.04 / $138.04	Professional		$138.04	$138.04	$138.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $109.65 / $144.54	Professional	26	$72.44	$109.65	$144.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $251.19 / $426.58	Professional	TC	$144.54	$251.19	$426.58
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $81.28 / $81.28	Facility	26	$81.28	$81.28	$81.28
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $398.11 / $512.86	Professional		$245.47	$398.11	$512.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $128.82 / $173.78	Professional	26	$81.28	$128.82	$173.78
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $269.15 / $346.74	Professional	TC	$162.18	$269.15	$346.74
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.74 / $346.74 / $346.74	Facility	26	$346.74	$346.74	$346.74
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $380.19 / $512.86	Professional		$251.19	$380.19	$512.86
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $128.82 / $169.82	Professional	26	$85.11	$128.82	$169.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $257.04 / $346.74	Professional	TC	$165.96	$257.04	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $257.04 / $512.86	Professional		$165.96	$257.04	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $67.61 / $162.18	Professional	26	$51.29	$67.61	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $169.82 / $354.81	Professional	TC	$109.65	$169.82	$354.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $208.93 / $338.84	Professional		$177.83	$208.93	$338.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $67.61 / $112.20	Professional	26	$58.88	$67.61	$112.20
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $138.04 / $229.09	Professional	TC	$120.23	$138.04	$229.09