Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $141.25 / $213.80	Facility	26	$85.11	$141.25	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $371.54 / $1,412.54	Professional		$199.53	$371.54	$1,412.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $109.65 / $251.19	Professional	26	$64.57	$109.65	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $208.93 / $426.58	Professional	TC	$128.82	$208.93	$426.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $416.87 / $467.74	Professional		$154.88	$416.87	$467.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $56.23 / $144.54	Professional	26	$56.23	$56.23	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $363.08 / $724.44	Professional		$213.80	$363.08	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $109.65 / $223.87	Professional	26	$63.10	$109.65	$223.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $251.19 / $489.78	Professional	TC	$141.25	$251.19	$489.78
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $147.91 / $229.09	Facility	26	$89.13	$147.91	$229.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $436.52 / $616.60	Professional		$251.19	$436.52	$616.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $138.04 / $190.55	Professional	26	$75.86	$138.04	$190.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $302.00 / $426.58	Professional	TC	$177.83	$302.00	$426.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $93.33	Professional		$32.36	$33.11	$93.33
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $147.91 / $151.36	Facility	26	$123.03	$147.91	$151.36
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $123.03 / $147.91	Professional	26	$89.13	$123.03	$147.91
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $288.40 / $302.00	Professional	TC	$239.88	$288.40	$302.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $102.33 / $102.33	Facility	26	$102.33	$102.33	$102.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $501.19 / $660.69	Professional		$309.03	$501.19	$660.69
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $162.18 / $218.78	Professional	26	$102.33	$162.18	$218.78
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $338.84 / $436.52	Professional	TC	$204.17	$338.84	$436.52
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 $316.23 / $478.63 / $645.65	Professional		$316.23	$478.63	$645.65
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $158.49 / $208.93	Professional	26	$104.71	$158.49	$208.93
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $323.59 / $426.58	Professional	TC	$213.80	$323.59	$426.58
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $467.74 / $1,047.13	Professional		$218.78	$467.74	$1,047.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $85.11 / $213.80	Professional	26	$64.57	$85.11	$213.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $331.13 / $870.96	Professional	TC	$147.91	$331.13	$870.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $257.04 / $426.58	Professional		$223.87	$257.04	$426.58
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $85.11 / $141.25	Professional	26	$74.13	$85.11	$141.25
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $173.78 / $288.40	Professional	TC	$151.36	$173.78	$288.40