Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.23 / $199.53 / $389.05	Facility	26	$120.23	$199.53	$389.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $602.56 / $2,818.38	Professional		$398.11	$602.56	$2,818.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $165.96 / $467.74	Professional	26	$104.71	$165.96	$467.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $436.52 / $1,071.52	Professional	TC	$281.84	$436.52	$1,071.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $954.99 / $954.99	Professional		$954.99	$954.99	$954.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $165.96 / $208.93	Professional	26	$79.43	$165.96	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $954.99 / $1,621.81	Professional		$489.78	$954.99	$1,621.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $158.49 / $316.23	Professional	26	$89.13	$158.49	$316.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $776.25 / $1,412.54	Professional	TC	$389.05	$776.25	$1,412.54
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $208.93 / $1,000.00	Facility	26	$123.03	$208.93	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $1,096.48 / $1,380.38	Professional		$630.96	$1,096.48	$1,380.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $194.98 / $269.15	Professional	26	$104.71	$194.98	$269.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $870.96 / $1,202.26	Professional	TC	$512.86	$870.96	$1,202.26
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $234.42	Professional		$32.36	$33.11	$234.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $173.78 / $208.93 / $218.78	Facility	26	$173.78	$208.93	$218.78
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $194.98 / $239.88	Professional	26	$128.82	$194.98	$239.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $537.03 / $831.76 / $1,258.93	Professional	TC	$537.03	$831.76	$1,258.93
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $144.54 / $144.54 / $144.54	Facility	26	$144.54	$144.54	$144.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $1,096.48 / $1,445.44	Professional		$660.69	$1,096.48	$1,445.44
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $234.42 / $309.03	Professional	26	$144.54	$234.42	$309.03
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $870.96 / $1,122.02	Professional	TC	$524.81	$870.96	$1,122.02
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 $691.83 / $1,071.52 / $1,380.38	Professional		$691.83	$1,071.52	$1,380.38
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $223.87 / $295.12	Professional	26	$151.36	$223.87	$295.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $851.14 / $1,096.48	Professional	TC	$549.54	$851.14	$1,096.48
United Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $724.44 / $1,513.56	Professional		$478.63	$724.44	$1,513.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $120.23 / $295.12	Professional	26	$91.20	$120.23	$295.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $602.56 / $1,202.26	Professional	TC	$380.19	$602.56	$1,202.26
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $549.54 / $912.01	Professional		$478.63	$549.54	$912.01
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $120.23 / $199.53	Professional	26	$104.71	$120.23	$199.53
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $426.58 / $707.95	Professional	TC	$371.54	$426.58	$707.95