Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $181.97 / $331.13	Facility	26	$114.82	$181.97	$331.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $524.81 / $2,187.76	Professional		$251.19	$524.81	$2,187.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $165.96 / $537.03	Professional	26	$100.00	$165.96	$537.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $416.87 / $1,000.00	Professional	TC	$281.84	$416.87	$1,000.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $691.83 / $1,000.00	Professional		$288.40	$691.83	$1,000.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $177.83 / $199.53	Professional	26	$75.86	$177.83	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $812.83 / $1,479.11	Professional		$426.58	$812.83	$1,479.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $151.36 / $302.00	Professional	26	$85.11	$151.36	$302.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $660.69 / $1,230.27	Professional	TC	$323.59	$660.69	$1,230.27
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $199.53 / $1,000.00	Facility	26	$117.49	$199.53	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $954.99 / $1,258.93	Professional		$537.03	$954.99	$1,258.93
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $186.21 / $257.04	Professional	26	$100.00	$186.21	$257.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $436.52 / $741.31 / $1,071.52	Professional	TC	$436.52	$741.31	$1,071.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $199.53	Professional		$32.36	$33.11	$199.53
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $154.88 / $199.53 / $204.17	Facility	26	$154.88	$199.53	$204.17
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $288.40 / $489.78	Professional		$288.40	$288.40	$489.78
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $186.21 / $223.87	Professional	26	$141.25	$186.21	$223.87
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $676.08 / $1,096.48	Professional	TC	$512.86	$676.08	$1,096.48
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $138.04 / $138.04	Facility	26	$138.04	$138.04	$138.04
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $954.99 / $1,258.93	Professional		$575.44	$954.99	$1,258.93
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $213.80 / $295.12	Professional	26	$138.04	$213.80	$295.12
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $436.52 / $741.31 / $954.99	Professional	TC	$436.52	$741.31	$954.99
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 $602.56 / $912.01 / $1,202.26	Professional		$602.56	$912.01	$1,202.26
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $213.80 / $281.84	Professional	26	$141.25	$213.80	$281.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $707.95 / $933.25	Professional	TC	$467.74	$707.95	$933.25
United Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $645.65 / $1,288.25	Professional		$416.87	$645.65	$1,288.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $114.82 / $281.84	Professional	26	$87.10	$114.82	$281.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $512.86 / $1,023.29	Professional	TC	$323.59	$512.86	$1,023.29
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $489.78 / $812.83	Professional		$426.58	$489.78	$812.83
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $114.82 / $190.55	Professional	26	$100.00	$114.82	$190.55
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $371.54 / $616.60	Professional	TC	$323.59	$371.54	$616.60