Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $165.96 / $331.13	Facility	26	$114.82	$165.96	$331.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $537.03 / $2,511.89	Professional		$354.81	$537.03	$2,511.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $186.21 / $549.54	Professional	26	$102.33	$186.21	$549.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $363.08 / $1,258.93	Professional	TC	$251.19	$363.08	$1,258.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $645.65 / $1,023.29	Professional		$234.42	$645.65	$1,023.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $173.78 / $269.15	Professional	26	$75.86	$173.78	$269.15
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $467.74 / $467.74	Professional	TC	$467.74	$467.74	$467.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $724.44 / $1,348.96	Professional		$346.74	$724.44	$1,348.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $151.36 / $302.00	Professional	26	$85.11	$151.36	$302.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $537.03 / $1,122.02	Professional	TC	$245.47	$537.03	$1,122.02
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $199.53 / $1,000.00	Facility	26	$117.49	$199.53	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $812.83 / $1,174.90	Professional		$478.63	$812.83	$1,174.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $186.21 / $257.04	Professional	26	$100.00	$186.21	$257.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $616.60 / $933.25	Professional	TC	$363.08	$616.60	$933.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $154.88	Professional		$32.36	$33.11	$154.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $165.96 / $199.53 / $204.17	Facility	26	$165.96	$199.53	$204.17
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $177.83 / $213.80	Professional	26	$123.03	$177.83	$213.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $588.84 / $1,096.48	Professional	TC	$363.08	$588.84	$1,096.48
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $134.90 / $134.90 / $138.04	Facility	26	$134.90	$134.90	$138.04
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $794.33 / $1,023.29	Professional		$478.63	$794.33	$1,023.29
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $213.80 / $295.12	Professional	26	$138.04	$213.80	$295.12
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $575.44 / $741.31	Professional	TC	$338.84	$575.44	$741.31
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $707.95 / $707.95 / $707.95	Facility	26	$707.95	$707.95	$707.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $758.58 / $1,023.29	Professional		$489.78	$758.58	$1,023.29
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $213.80 / $281.84	Professional	26	$141.25	$213.80	$281.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $549.54 / $741.31	Professional	TC	$354.81	$549.54	$741.31
United Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $575.44 / $1,202.26	Professional		$338.84	$575.44	$1,202.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $114.82 / $281.84	Professional	26	$87.10	$114.82	$281.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $436.52 / $912.01	Professional	TC	$245.47	$436.52	$912.01
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $407.38 / $660.69	Professional		$346.74	$407.38	$660.69
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $114.82 / $190.55	Professional	26	$100.00	$114.82	$190.55
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $288.40 / $478.63	Professional	TC	$251.19	$288.40	$478.63