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 $239.88 / $354.81 / $851.14	Professional		$239.88	$354.81	$851.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $93.33 / $295.12	Professional	26	$66.07	$93.33	$295.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $229.09 / $512.86	Professional	TC	$162.18	$229.09	$512.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $134.90 / $134.90	Professional	26	$134.90	$134.90	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $562.34 / $1,023.29	Professional		$295.12	$562.34	$1,023.29
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 $204.17 / $436.52 / $758.58	Professional	TC	$204.17	$436.52	$758.58
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $165.96 / $489.78	Facility	26	$97.72	$165.96	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $616.60 / $851.14	Professional		$363.08	$616.60	$851.14
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 $263.03 / $467.74 / $660.69	Professional	TC	$263.03	$467.74	$660.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $144.54	Professional		$32.36	$33.11	$144.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $165.96 / $173.78	Facility	26	$138.04	$165.96	$173.78
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $154.88 / $190.55	Professional	26	$102.33	$154.88	$190.55
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $436.52 / $630.96	Professional	TC	$275.42	$436.52	$630.96
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 $426.58 / $707.95 / $912.01	Professional		$426.58	$707.95	$912.01
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 $316.23 / $512.86 / $676.08	Professional	TC	$316.23	$512.86	$676.08
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.74 / $346.74 / $346.74	Facility	26	$346.74	$346.74	$346.74
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $676.08 / $891.25	Professional		$446.68	$676.08	$891.25
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 $323.59 / $501.19 / $660.69	Professional	TC	$323.59	$501.19	$660.69
United Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $416.87 / $870.96	Professional		$275.42	$416.87	$870.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $95.50 / $223.87	Professional	26	$74.13	$95.50	$223.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $316.23 / $630.96	Professional	TC	$199.53	$316.23	$630.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $309.03 / $512.86	Professional		$269.15	$309.03	$512.86
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 $186.21 / $218.78 / $354.81	Professional	TC	$186.21	$218.78	$354.81