Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $281.84 / $954.99	Facility		$181.97	$281.84	$954.99
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $40.74 / $64.57	Facility	26	$29.51	$40.74	$64.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $141.25 / $346.74	Professional		$102.33	$141.25	$346.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $23.99 / $53.70	Professional	26	$12.88	$23.99	$53.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $117.49 / $213.80	Professional	TC	$95.50	$117.49	$213.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $138.04 / $295.12	Professional		$93.33	$138.04	$295.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $36.31 / $44.67	Professional	26	$15.49	$36.31	$44.67
Cigna Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $371.54 / $446.68	Facility		$234.42	$371.54	$446.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $269.15 / $467.74	Professional		$154.88	$269.15	$467.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $34.67 / $69.18	Professional	26	$16.60	$34.67	$69.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $234.42 / $407.38	Professional	TC	$134.90	$234.42	$407.38
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $302.00 / $457.09	Facility		$144.54	$302.00	$457.09
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $16.22 / $38.02 / $288.40	Facility	26	$16.22	$38.02	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $281.84 / $416.87	Professional		$158.49	$281.84	$416.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $33.88 / $53.70	Professional	26	$16.60	$33.88	$53.70
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $257.04 / $354.81	Professional	TC	$134.90	$257.04	$354.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $81.28	Professional		$32.36	$33.11	$81.28
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $239.88 / $281.84 / $346.74	Facility		$239.88	$281.84	$346.74
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $43.65 / $47.86	Facility	26	$23.99	$43.65	$47.86
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $28.18 / $53.70	Professional	26	$17.78	$28.18	$53.70
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $263.03 / $338.84	Professional	TC	$169.82	$263.03	$338.84
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $302.00 / $416.87	Professional		$199.53	$302.00	$416.87
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $48.98 / $66.07	Professional	26	$31.62	$48.98	$66.07
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $257.04 / $354.81	Professional	TC	$169.82	$257.04	$354.81
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $218.78 / $218.78	Facility		$218.78	$218.78	$218.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $288.40 / $371.54	Professional		$204.17	$288.40	$371.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $44.67 / $58.88	Professional	26	$31.62	$44.67	$58.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $245.47 / $316.23	Professional	TC	$173.78	$245.47	$316.23
United Facility/Professional Facility Modifier Low / Median / High Price $354.81 / $416.87 / $537.03	Facility		$354.81	$416.87	$537.03
United Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $239.88 / $380.19	Professional		$147.91	$239.88	$380.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $32.36 / $60.26	Professional	26	$17.38	$32.36	$60.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $208.93 / $323.59	Professional	TC	$128.82	$208.93	$323.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $154.88 / $257.04	Professional		$134.90	$154.88	$257.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $25.70 / $42.66	Professional	26	$22.39	$25.70	$42.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $131.83 / $213.80	Professional	TC	$112.20	$131.83	$213.80