Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $107.15 / $234.42	Facility	26	$93.33	$107.15	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $389.05 / $1,584.89	Professional		$245.47	$389.05	$1,584.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $97.72 / $323.59	Professional	26	$74.13	$97.72	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $245.47 / $562.34	Professional	TC	$162.18	$245.47	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $501.19 / $794.33	Professional		$181.97	$501.19	$794.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $144.54 / $162.18	Professional	26	$64.57	$144.54	$162.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $354.81 / $354.81	Professional	TC	$354.81	$354.81	$354.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $537.03 / $1,023.29	Professional		$269.15	$537.03	$1,023.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $123.03 / $245.47	Professional	26	$69.18	$123.03	$245.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $416.87 / $831.76	Professional	TC	$190.55	$416.87	$831.76
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $162.18 / $489.78	Facility	26	$95.50	$162.18	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $630.96 / $933.25	Professional		$354.81	$630.96	$933.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $151.36 / $208.93	Professional	26	$81.28	$151.36	$208.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $467.74 / $812.83	Professional	TC	$251.19	$467.74	$812.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $128.82	Professional		$32.36	$33.11	$128.82
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $134.90 / $162.18 / $165.96	Facility	26	$134.90	$162.18	$165.96
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $151.36 / $173.78	Professional	26	$112.20	$151.36	$173.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $426.58 / $870.96	Professional	TC	$275.42	$426.58	$870.96
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $112.20 / $112.20	Facility	26	$112.20	$112.20	$112.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $630.96 / $831.76	Professional		$389.05	$630.96	$831.76
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $177.83 / $239.88	Professional	26	$112.20	$177.83	$239.88
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $457.09 / $602.56	Professional	TC	$275.42	$457.09	$602.56
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 $398.11 / $602.56 / $831.76	Professional		$398.11	$602.56	$831.76
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $173.78 / $229.09	Professional	26	$114.82	$173.78	$229.09
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $436.52 / $645.65	Professional	TC	$281.84	$436.52	$645.65
United Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $446.68 / $831.76	Professional		$251.19	$446.68	$831.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $93.33 / $218.78	Professional	26	$70.79	$93.33	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $331.13 / $616.60	Professional	TC	$177.83	$331.13	$616.60
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 $81.28 / $93.33 / $154.88	Professional	26	$81.28	$93.33	$154.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $218.78 / $354.81	Professional	TC	$190.55	$218.78	$354.81