Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $158.49 / $309.03	Facility	26	$95.50	$158.49	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $446.68 / $1,096.48	Professional		$275.42	$446.68	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $141.25 / $416.87	Professional	26	$85.11	$141.25	$416.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $316.23 / $588.84	Professional	TC	$190.55	$316.23	$588.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $141.25 / $141.25	Professional	26	$141.25	$141.25	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $562.34 / $1,047.13	Professional		$275.42	$562.34	$1,047.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $125.89 / $251.19	Professional	26	$72.44	$125.89	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $416.87 / $870.96	Professional	TC	$194.98	$416.87	$870.96
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $165.96 / $1,000.00	Facility	26	$97.72	$165.96	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $645.65 / $933.25	Professional		$380.19	$645.65	$933.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $154.88 / $213.80	Professional	26	$83.18	$154.88	$213.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $478.63 / $794.33	Professional	TC	$281.84	$478.63	$794.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $123.03	Professional		$32.36	$33.11	$123.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $165.96 / $169.82	Facility	26	$138.04	$165.96	$169.82
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $295.12 / $295.12	Professional		$295.12	$295.12	$295.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $144.54 / $177.83	Professional	26	$102.33	$144.54	$177.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $389.05 / $794.33	Professional	TC	$269.15	$389.05	$794.33
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $114.82 / $114.82	Facility	26	$114.82	$114.82	$114.82
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $630.96 / $831.76	Professional		$380.19	$630.96	$831.76
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $181.97 / $245.47	Professional	26	$114.82	$181.97	$245.47
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $436.52 / $575.44	Professional	TC	$269.15	$436.52	$575.44
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 $398.11 / $602.56 / $794.33	Professional		$398.11	$602.56	$794.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $177.83 / $234.42	Professional	26	$117.49	$177.83	$234.42
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $426.58 / $575.44	Professional	TC	$275.42	$426.58	$575.44
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $457.09 / $870.96	Professional		$269.15	$457.09	$870.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $95.50 / $234.42	Professional	26	$72.44	$95.50	$234.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $338.84 / $630.96	Professional	TC	$190.55	$338.84	$630.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $323.59 / $537.03	Professional		$281.84	$323.59	$537.03
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $95.50 / $158.49	Professional	26	$83.18	$95.50	$158.49
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $229.09 / $371.54	Professional	TC	$194.98	$229.09	$371.54