Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $131.83 / $275.42	Facility	26	$79.43	$131.83	$275.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $524.81 / $1,905.46	Professional		$338.84	$524.81	$1,905.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $141.25 / $371.54	Professional	26	$70.79	$141.25	$371.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $363.08 / $870.96	Professional	TC	$257.04	$363.08	$870.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $645.65 / $645.65	Professional		$645.65	$645.65	$645.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $112.20 / $120.23	Professional	26	$51.29	$112.20	$120.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $724.44 / $1,513.56	Professional		$338.84	$724.44	$1,513.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $109.65 / $208.93	Professional	26	$58.88	$109.65	$208.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $602.56 / $1,288.25	Professional	TC	$275.42	$602.56	$1,288.25
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $144.54 / $1,000.00	Facility	26	$89.13	$144.54	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $891.25 / $1,380.38	Professional		$512.86	$891.25	$1,380.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $138.04 / $177.83	Professional	26	$79.43	$138.04	$177.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $741.31 / $1,230.27	Professional	TC	$416.87	$741.31	$1,230.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $169.82	Professional		$32.36	$33.11	$169.82
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $138.04 / $173.78	Facility	26	$114.82	$138.04	$173.78
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $489.78 / $489.78	Professional		$489.78	$489.78	$489.78
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $147.91 / $173.78	Professional	26	$102.33	$147.91	$173.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $831.76 / $1,174.90	Professional	TC	$489.78	$831.76	$1,174.90
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $95.50 / $95.50	Facility	26	$95.50	$95.50	$95.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $776.25 / $1,000.00	Professional		$467.74	$776.25	$1,000.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $154.88 / $204.17	Professional	26	$95.50	$154.88	$204.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $630.96 / $812.83	Professional	TC	$371.54	$630.96	$812.83
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 $478.63 / $741.31 / $1,096.48	Professional		$478.63	$741.31	$1,096.48
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $147.91 / $194.98	Professional	26	$97.72	$147.91	$194.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $588.84 / $891.25	Professional	TC	$380.19	$588.84	$891.25
United Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $616.60 / $1,230.27	Professional		$323.59	$616.60	$1,230.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $83.18 / $199.53	Professional	26	$64.57	$83.18	$199.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $512.86 / $1,023.29	Professional	TC	$257.04	$512.86	$1,023.29
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $389.05 / $645.65	Professional		$338.84	$389.05	$645.65
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $79.43 / $131.83	Professional	26	$69.18	$79.43	$131.83
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $316.23 / $524.81	Professional	TC	$275.42	$316.23	$524.81