Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $107.15 / $186.21	Facility	26	$74.13	$107.15	$186.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $363.08 / $1,318.26	Professional		$223.87	$363.08	$1,318.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $91.20 / $239.88	Professional	26	$57.54	$91.20	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $245.47 / $660.69	Professional	TC	$162.18	$245.47	$660.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $478.63 / $758.58	Professional		$173.78	$478.63	$758.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $114.82 / $128.82	Professional	26	$48.98	$114.82	$128.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $338.84 / $398.11	Professional	TC	$338.84	$338.84	$398.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $478.63 / $870.96	Professional		$251.19	$478.63	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $97.72 / $194.98	Professional	26	$54.95	$97.72	$194.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $380.19 / $691.83	Professional	TC	$181.97	$380.19	$691.83
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $128.82 / $489.78	Facility	26	$75.86	$128.82	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $549.54 / $741.31	Professional		$302.00	$549.54	$741.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $123.03 / $165.96	Professional	26	$66.07	$123.03	$165.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $416.87 / $588.84	Professional	TC	$234.42	$416.87	$588.84
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 $107.15 / $128.82 / $134.90	Facility	26	$107.15	$128.82	$134.90
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $257.04 / $257.04	Professional		$257.04	$257.04	$257.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $117.49 / $151.36	Professional	26	$91.20	$117.49	$151.36
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $363.08 / $549.54	Professional	TC	$245.47	$363.08	$549.54
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $89.13 / $89.13	Facility	26	$89.13	$89.13	$89.13
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $602.56 / $776.25	Professional		$371.54	$602.56	$776.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $141.25 / $190.55	Professional	26	$89.13	$141.25	$190.55
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $457.09 / $588.84	Professional	TC	$281.84	$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 $380.19 / $562.34 / $776.25	Professional		$380.19	$562.34	$776.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $141.25 / $181.97	Professional	26	$93.33	$141.25	$181.97
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $436.52 / $588.84	Professional	TC	$295.12	$436.52	$588.84
United Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $354.81 / $758.58	Professional		$234.42	$354.81	$758.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $75.86 / $177.83	Professional	26	$57.54	$75.86	$177.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $281.84 / $562.34	Professional	TC	$177.83	$281.84	$562.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $288.40 / $478.63	Professional		$251.19	$288.40	$478.63
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $74.13 / $123.03	Professional	26	$64.57	$74.13	$123.03
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $218.78 / $354.81	Professional	TC	$190.55	$218.78	$354.81