Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $141.25 / $251.19	Facility	26	$87.10	$141.25	$251.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $338.84 / $1,380.38	Professional		$218.78	$338.84	$1,380.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $95.50 / $234.42	Professional	26	$61.66	$95.50	$234.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $218.78 / $489.78	Professional	TC	$144.54	$218.78	$489.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $154.88 / $154.88	Professional		$154.88	$154.88	$154.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $56.23 / $123.03	Professional	26	$56.23	$56.23	$123.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $275.42 / $275.42	Professional	TC	$275.42	$275.42	$275.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $416.87 / $724.44	Professional		$229.09	$416.87	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $109.65 / $223.87	Professional	26	$63.10	$109.65	$223.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $295.12 / $562.34	Professional	TC	$151.36	$295.12	$562.34
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $144.54 / $489.78	Facility	26	$83.18	$144.54	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $489.78 / $645.65	Professional		$288.40	$489.78	$645.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $134.90 / $190.55	Professional	26	$75.86	$134.90	$190.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $346.74 / $478.63	Professional	TC	$204.17	$346.74	$478.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $95.50	Professional		$32.36	$33.11	$95.50
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $144.54 / $154.88	Facility	26	$117.49	$144.54	$154.88
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Professional		$109.65	$109.65	$109.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $123.03 / $158.49	Professional	26	$83.18	$123.03	$158.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $354.81 / $512.86	Professional	TC	$208.93	$354.81	$512.86
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $102.33 / $102.33	Facility	26	$102.33	$102.33	$102.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $512.86 / $660.69	Professional		$309.03	$512.86	$660.69
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $162.18 / $218.78	Professional	26	$102.33	$162.18	$218.78
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 $346.74 / $346.74 / $346.74	Facility	26	$346.74	$346.74	$346.74
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $489.78 / $645.65	Professional		$316.23	$489.78	$645.65
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $162.18 / $213.80	Professional	26	$107.15	$162.18	$213.80
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $331.13 / $446.68	Professional	TC	$213.80	$331.13	$446.68
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $316.23 / $660.69	Professional		$213.80	$316.23	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $83.18 / $199.53	Professional	26	$60.26	$83.18	$199.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $229.09 / $446.68	Professional	TC	$141.25	$229.09	$446.68
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $263.03 / $436.52	Professional		$229.09	$263.03	$436.52
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $85.11 / $141.25	Professional	26	$74.13	$85.11	$141.25
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $177.83 / $288.40	Professional	TC	$154.88	$177.83	$288.40