Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $104.71 / $199.53	Facility	26	$79.43	$104.71	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $478.63 / $1,348.96	Professional		$208.93	$478.63	$1,348.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $128.82 / $338.84	Professional	26	$67.61	$128.82	$338.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $123.03 / $512.86 / $870.96	Professional	52	$123.03	$512.86	$870.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $229.09 / $630.96	Professional	TC	$109.65	$229.09	$630.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $371.54 / $794.33	Professional		$131.83	$371.54	$794.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $117.49 / $138.04	Professional	26	$52.48	$117.49	$138.04
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $229.09 / $288.40	Professional	TC	$229.09	$229.09	$288.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $407.38 / $831.76	Professional		$194.98	$407.38	$831.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $107.15 / $204.17	Professional	26	$58.88	$107.15	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $281.84 / $645.65	Professional	TC	$125.89	$281.84	$645.65
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $138.04 / $630.96	Facility	26	$87.10	$138.04	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $467.74 / $758.58	Professional		$269.15	$467.74	$758.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $131.83 / $181.97	Professional	26	$72.44	$131.83	$181.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $323.59 / $616.60	Professional	TC	$181.97	$323.59	$616.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $79.43	Professional		$32.36	$33.11	$79.43
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 26 Low / Median / High Price $89.13 / $128.82 / $158.49	Professional	26	$89.13	$128.82	$158.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $281.84 / $660.69	Professional	TC	$181.97	$281.84	$660.69
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $95.50 / $95.50	Facility	26	$95.50	$95.50	$95.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $436.52 / $575.44	Professional		$269.15	$436.52	$575.44
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $151.36 / $204.17	Professional	26	$95.50	$151.36	$204.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $288.40 / $380.19	Professional	TC	$173.78	$288.40	$380.19
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 $275.42 / $416.87 / $562.34	Professional		$275.42	$416.87	$562.34
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 $177.83 / $275.42 / $371.54	Professional	TC	$177.83	$275.42	$371.54
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $338.84 / $676.08	Professional		$186.21	$338.84	$676.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $81.28 / $194.98	Professional	26	$63.10	$81.28	$194.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $223.87 / $467.74	Professional	TC	$123.03	$223.87	$467.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $229.09 / $380.19	Professional		$199.53	$229.09	$380.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $79.43 / $131.83	Professional	26	$69.18	$79.43	$131.83
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $147.91 / $245.47	Professional	TC	$128.82	$147.91	$245.47