Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $95.50 / $151.36	Facility	26	$70.79	$95.50	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $363.08 / $1,230.27	Professional		$245.47	$363.08	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $107.15 / $363.08	Professional	26	$52.48	$107.15	$363.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $239.88 / $660.69	Professional	TC	$173.78	$239.88	$660.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $446.68 / $549.54	Professional		$269.15	$446.68	$549.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $91.20 / $104.71	Professional	26	$40.74	$91.20	$104.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $61.66 / $89.13	Facility	26	$13.18	$61.66	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $489.78 / $870.96	Professional		$302.00	$489.78	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $104.71 / $186.21	Professional	26	$60.26	$104.71	$186.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $389.05 / $707.95	Professional	TC	$234.42	$389.05	$707.95
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $117.49 / $630.96	Facility	26	$81.28	$117.49	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $549.54 / $741.31	Professional		$346.74	$549.54	$741.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $114.82 / $147.91	Professional	26	$81.28	$114.82	$147.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $436.52 / $602.56	Professional	TC	$275.42	$436.52	$602.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $138.04	Professional		$32.36	$33.11	$138.04
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $107.15 / $165.96	Facility	26	$89.13	$107.15	$165.96
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Professional		$125.89	$125.89	$125.89
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $109.65 / $165.96	Professional	26	$77.62	$109.65	$165.96
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $416.87 / $512.86	Professional	TC	$288.40	$416.87	$512.86
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $74.13 / $74.13	Facility	26	$74.13	$74.13	$74.13
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $575.44 / $758.58	Professional		$363.08	$575.44	$758.58
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $125.89 / $162.18	Professional	26	$74.13	$125.89	$162.18
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $467.74 / $616.60	Professional	TC	$288.40	$467.74	$616.60
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 $371.54 / $524.81 / $676.08	Professional		$371.54	$524.81	$676.08
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $107.15 / $144.54	Professional	26	$75.86	$107.15	$144.54
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $416.87 / $537.03	Professional	TC	$295.12	$416.87	$537.03
United Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $446.68 / $741.31	Professional		$281.84	$446.68	$741.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $95.50 / $154.88	Professional	26	$58.88	$95.50	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $354.81 / $588.84	Professional	TC	$223.87	$354.81	$588.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $309.03 / $512.86	Professional		$269.15	$309.03	$512.86
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $61.66 / $102.33	Professional	26	$53.70	$61.66	$102.33
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $251.19 / $407.38	Professional	TC	$218.78	$251.19	$407.38