Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $128.82 / $208.93	Facility	26	$93.33	$128.82	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $309.03 / $1,122.02	Professional		$213.80	$309.03	$1,122.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $64.57 / $173.78	Professional	26	$51.29	$64.57	$173.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $223.87 / $467.74	Professional	TC	$162.18	$223.87	$467.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $165.96 / $165.96	Professional		$165.96	$165.96	$165.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $91.20 / $91.20	Professional	26	$91.20	$91.20	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $446.68 / $851.14	Professional		$245.47	$446.68	$851.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $85.11 / $169.82	Professional	26	$48.98	$85.11	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $380.19 / $676.08	Professional	TC	$190.55	$380.19	$676.08
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $112.20 / $489.78	Facility	26	$66.07	$112.20	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $524.81 / $707.95	Professional		$288.40	$524.81	$707.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $107.15 / $144.54	Professional	26	$56.23	$107.15	$144.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $407.38 / $575.44	Professional	TC	$234.42	$407.38	$575.44
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 $93.33 / $112.20 / $117.49	Facility	26	$93.33	$112.20	$117.49
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $165.96 / $257.04	Professional		$165.96	$165.96	$257.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $91.20 / $123.03	Professional	26	$69.18	$91.20	$123.03
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $371.54 / $537.03	Professional	TC	$251.19	$371.54	$537.03
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $77.62 / $77.62	Facility	26	$77.62	$77.62	$77.62
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $588.84 / $758.58	Professional		$354.81	$588.84	$758.58
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $123.03 / $165.96	Professional	26	$77.62	$123.03	$165.96
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $457.09 / $588.84	Professional	TC	$275.42	$457.09	$588.84
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 $371.54 / $549.54 / $741.31	Professional		$371.54	$549.54	$741.31
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $123.03 / $158.49	Professional	26	$79.43	$123.03	$158.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $436.52 / $588.84	Professional	TC	$288.40	$436.52	$588.84
United Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $331.13 / $724.44	Professional		$229.09	$331.13	$724.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $64.57 / $154.88	Professional	26	$50.12	$64.57	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $269.15 / $562.34	Professional	TC	$177.83	$269.15	$562.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $281.84 / $467.74	Professional		$245.47	$281.84	$467.74
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $66.07 / $107.15	Professional	26	$56.23	$66.07	$107.15
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $218.78 / $354.81	Professional	TC	$190.55	$218.78	$354.81