Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $199.53 / $363.08	Facility	26	$104.71	$199.53	$363.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $213.80 / $794.33	Professional		$117.49	$213.80	$794.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $173.78 / $478.63	Professional	26	$93.33	$173.78	$478.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $63.10 / $162.18	Professional	TC	$23.99	$63.10	$162.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $154.88 / $223.87	Professional		$117.49	$154.88	$223.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $114.82 / $218.78	Professional	26	$91.20	$114.82	$218.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $295.12 / $457.09	Professional		$173.78	$295.12	$457.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $213.80 / $323.59	Professional	26	$128.82	$213.80	$323.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $69.18 / $120.23	Professional	TC	$39.81	$69.18	$120.23
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $239.88 / $2,570.40	Facility	26	$138.04	$239.88	$2,570.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $295.12 / $389.05	Professional		$177.83	$295.12	$389.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $223.87 / $288.40	Professional	26	$138.04	$223.87	$288.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $79.43 / $100.00	Professional	TC	$42.66	$79.43	$100.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $69.18	Professional		$32.36	$33.11	$69.18
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $204.17 / $213.80	Facility	26	$169.82	$204.17	$213.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $177.83 / $218.78	Professional	26	$134.90	$177.83	$218.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $66.07 / $144.54	Professional	TC	$44.67	$66.07	$144.54
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $141.25 / $144.54	Facility	26	$141.25	$141.25	$144.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $309.03 / $426.58	Professional		$194.98	$309.03	$426.58
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $239.88 / $316.23	Professional	26	$144.54	$239.88	$316.23
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $74.13 / $109.65	Professional	TC	$48.98	$74.13	$109.65
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,047.13 / $1,047.13 / $1,047.13	Facility	26	$1,047.13	$1,047.13	$1,047.13
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $281.84 / $398.11	Professional		$181.97	$281.84	$398.11
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $223.87 / $302.00	Professional	26	$144.54	$223.87	$302.00
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $66.07 / $93.33	Professional	TC	$38.90	$66.07	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $199.53 / $446.68	Professional		$141.25	$199.53	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $138.04 / $275.42	Professional	26	$93.33	$138.04	$275.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $47.86 / $194.98	Professional	TC	$28.18	$47.86	$194.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $199.53 / $281.84	Professional		$147.91	$199.53	$281.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $147.91 / $204.17	Professional	26	$109.65	$147.91	$204.17
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $54.95 / $77.62	Professional	TC	$40.74	$54.95	$77.62