Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $147.91 / $288.40 / $512.86	Facility	26	$147.91	$288.40	$512.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $302.00 / $891.25	Professional		$234.42	$302.00	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $204.17 / $549.54	Professional	26	$131.83	$204.17	$549.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $147.91 / $316.23	Professional	TC	$109.65	$147.91	$316.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $234.42 / $457.09	Professional		$234.42	$234.42	$457.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $151.36 / $309.03	Professional	26	$123.03	$151.36	$309.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $588.84 / $912.01	Professional		$354.81	$588.84	$912.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $186.21 / $309.03 / $457.09	Professional	26	$186.21	$309.03	$457.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $281.84 / $446.68	Professional	TC	$169.82	$281.84	$446.68
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $194.98 / $346.74 / $1,584.89	Facility	26	$194.98	$346.74	$1,584.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $616.60 / $812.83	Professional		$371.54	$616.60	$812.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $316.23 / $416.87	Professional	26	$194.98	$316.23	$416.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $309.03 / $407.38	Professional	TC	$177.83	$309.03	$407.38
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 $245.47 / $295.12 / $302.00	Facility	26	$245.47	$295.12	$302.00
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $229.09 / $302.00	Professional	26	$169.82	$229.09	$302.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $223.87 / $275.42	Professional	TC	$158.49	$223.87	$275.42
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $199.53 / $208.93	Facility	26	$199.53	$199.53	$208.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $645.65 / $851.14	Professional		$398.11	$645.65	$851.14
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $208.93 / $338.84 / $446.68	Professional	26	$208.93	$338.84	$446.68
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $302.00 / $398.11	Professional	TC	$186.21	$302.00	$398.11
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $660.69 / $660.69 / $660.69	Facility	26	$660.69	$660.69	$660.69
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $588.84 / $794.33	Professional		$380.19	$588.84	$794.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $316.23 / $426.58	Professional	26	$204.17	$316.23	$426.58
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 $257.04 / $371.54 / $741.31	Professional		$257.04	$371.54	$741.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $194.98 / $389.05	Professional	26	$134.90	$194.98	$389.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $173.78 / $346.74	Professional	TC	$123.03	$173.78	$346.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $407.38 / $575.44	Professional		$302.00	$407.38	$575.44
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $208.93 / $295.12	Professional	26	$154.88	$208.93	$295.12
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $194.98 / $275.42	Professional	TC	$144.54	$194.98	$275.42