Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $97.72 / $169.82	Facility	26	$67.61	$97.72	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $338.84 / $1,174.90	Professional		$229.09	$338.84	$1,174.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $93.33 / $257.04	Professional	26	$54.95	$93.33	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $234.42 / $575.44	Professional	TC	$162.18	$234.42	$575.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $436.52 / $501.19	Professional		$158.49	$436.52	$501.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $102.33 / $158.49	Professional	26	$44.67	$102.33	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $398.11 / $758.58	Professional		$223.87	$398.11	$758.58
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 $158.49 / $309.03 / $588.84	Professional	TC	$158.49	$309.03	$588.84
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 $263.03 / $467.74 / $645.65	Professional		$263.03	$467.74	$645.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $112.20 / $151.36	Professional	26	$58.88	$112.20	$151.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $354.81 / $501.19	Professional	TC	$204.17	$354.81	$501.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $112.20	Professional		$32.36	$33.11	$112.20
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 $144.54 / $144.54 / $144.54	Professional		$144.54	$144.54	$144.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $109.65 / $128.82	Professional	26	$72.44	$109.65	$128.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $316.23 / $467.74	Professional	TC	$213.80	$316.23	$467.74
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 $331.13 / $537.03 / $691.83	Professional		$331.13	$537.03	$691.83
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 $245.47 / $407.38 / $524.81	Professional	TC	$245.47	$407.38	$524.81
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 $346.74 / $501.19 / $691.83	Professional		$346.74	$501.19	$691.83
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 $257.04 / $380.19 / $524.81	Professional	TC	$257.04	$380.19	$524.81
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $302.00 / $660.69	Professional		$204.17	$302.00	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $67.61 / $162.18	Professional	26	$52.48	$67.61	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $229.09 / $489.78	Professional	TC	$151.36	$229.09	$489.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $275.42 / $457.09	Professional		$239.88	$275.42	$457.09
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 $181.97 / $208.93 / $346.74	Professional	TC	$181.97	$208.93	$346.74