Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $190.55 / $354.81	Facility	26	$123.03	$190.55	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $524.81 / $2,398.83	Professional		$331.13	$524.81	$2,398.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $199.53 / $562.34	Professional	26	$104.71	$199.53	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $338.84 / $812.83	Professional	TC	$218.78	$338.84	$812.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $549.54 / $954.99	Professional		$446.68	$549.54	$954.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $181.97 / $288.40	Professional	26	$81.28	$181.97	$288.40
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $154.88 / $426.58	Professional	TC	$154.88	$154.88	$426.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $676.08 / $1,258.93	Professional		$331.13	$676.08	$1,258.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $169.82 / $316.23	Professional	26	$91.20	$169.82	$316.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $478.63 / $1,023.29	Professional	TC	$223.87	$478.63	$1,023.29
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $213.80 / $1,000.00	Facility	26	$138.04	$213.80	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $758.58 / $1,096.48	Professional		$436.52	$758.58	$1,096.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $208.93 / $275.42	Professional	26	$114.82	$208.93	$275.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $549.54 / $812.83	Professional	TC	$323.59	$549.54	$812.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $138.04	Professional		$32.36	$33.11	$138.04
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $177.83 / $213.80 / $218.78	Facility	26	$177.83	$213.80	$218.78
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $194.98 / $245.47	Professional	26	$131.83	$194.98	$245.47
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $457.09 / $891.25	Professional	TC	$316.23	$457.09	$891.25
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $144.54 / $144.54 / $147.91	Facility	26	$144.54	$144.54	$147.91
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $741.31 / $977.24	Professional		$457.09	$741.31	$977.24
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $234.42 / $316.23	Professional	26	$147.91	$234.42	$316.23
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $501.19 / $660.69	Professional	TC	$302.00	$501.19	$660.69
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 $467.74 / $707.95 / $954.99	Professional		$467.74	$707.95	$954.99
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $229.09 / $302.00	Professional	26	$151.36	$229.09	$302.00
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $489.78 / $660.69	Professional	TC	$316.23	$489.78	$660.69
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $537.03 / $1,148.15	Professional		$316.23	$537.03	$1,148.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $125.89 / $302.00	Professional	26	$100.00	$125.89	$302.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $380.19 / $851.14	Professional	TC	$218.78	$380.19	$851.14
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $380.19 / $630.96	Professional		$331.13	$380.19	$630.96
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $123.03 / $204.17	Professional	26	$107.15	$123.03	$204.17
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $257.04 / $426.58	Professional	TC	$223.87	$257.04	$426.58