Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $158.49 / $208.93	Facility	26	$81.28	$158.49	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $426.58 / $1,548.82	Professional		$251.19	$426.58	$1,548.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $123.03 / $316.23	Professional	26	$70.79	$123.03	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $302.00 / $562.34	Professional	TC	$186.21	$302.00	$562.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $123.03 / $138.04	Professional	26	$123.03	$123.03	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $537.03 / $1,023.29	Professional		$251.19	$537.03	$1,023.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $97.72 / $208.93	Professional	26	$52.48	$97.72	$208.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $407.38 / $831.76	Professional	TC	$190.55	$407.38	$831.76
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $134.90 / $1,000.00	Facility	26	$70.79	$134.90	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $645.65 / $912.01	Professional		$380.19	$645.65	$912.01
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $117.49 / $177.83	Professional	26	$66.07	$117.49	$177.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $512.86 / $812.83	Professional	TC	$288.40	$512.86	$812.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $114.82	Professional		$32.36	$33.11	$114.82
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $134.90 / $141.25	Facility	26	$97.72	$134.90	$141.25
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $354.81 / $354.81	Professional		$354.81	$354.81	$354.81
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $102.33 / $147.91	Professional	26	$75.86	$102.33	$147.91
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $588.84 / $870.96	Professional	TC	$338.84	$588.84	$870.96
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 $346.74 / $588.84 / $758.58	Professional		$346.74	$588.84	$758.58
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $151.36 / $204.17	Professional	26	$95.50	$151.36	$204.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $426.58 / $549.54	Professional	TC	$251.19	$426.58	$549.54
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 $354.81 / $549.54 / $758.58	Professional		$354.81	$549.54	$758.58
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $147.91 / $199.53	Professional	26	$97.72	$147.91	$199.53
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $398.11 / $602.56	Professional	TC	$257.04	$398.11	$602.56
United Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $436.52 / $831.76	Professional		$239.88	$436.52	$831.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $77.62 / $194.98	Professional	26	$48.98	$77.62	$194.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $346.74 / $691.83	Professional	TC	$173.78	$346.74	$691.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $295.12 / $489.78	Professional		$257.04	$295.12	$489.78
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 $186.21 / $213.80 / $354.81	Professional	TC	$186.21	$213.80	$354.81