Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $165.96 / $331.13	Facility	26	$114.82	$165.96	$331.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $478.63 / $2,187.76	Professional		$239.88	$478.63	$2,187.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $190.55 / $537.03	Professional	26	$97.72	$190.55	$537.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $346.74 / $1,000.00	Professional	TC	$245.47	$346.74	$1,000.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $660.69 / $1,023.29	Professional		$234.42	$660.69	$1,023.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $165.96 / $186.21	Professional	26	$75.86	$165.96	$186.21
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $398.11 / $398.11	Professional	TC	$398.11	$398.11	$398.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $741.31 / $1,380.38	Professional		$346.74	$741.31	$1,380.38
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 $245.47 / $549.54 / $1,148.15	Professional	TC	$245.47	$549.54	$1,148.15
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 $489.78 / $851.14 / $1,202.26	Professional		$489.78	$851.14	$1,202.26
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 $371.54 / $645.65 / $954.99	Professional	TC	$371.54	$645.65	$954.99
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $154.88	Professional		$32.36	$33.11	$154.88
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 $229.09 / $295.12 / $316.23	Professional		$229.09	$295.12	$316.23
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $181.97 / $223.87	Professional	26	$138.04	$181.97	$223.87
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $660.69 / $1,096.48	Professional	TC	$457.09	$660.69	$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 $478.63 / $794.33 / $1,023.29	Professional		$478.63	$794.33	$1,023.29
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 $338.84 / $575.44 / $741.31	Professional	TC	$338.84	$575.44	$741.31
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 $489.78 / $758.58 / $1,023.29	Professional		$489.78	$758.58	$1,023.29
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 $354.81 / $549.54 / $741.31	Professional	TC	$354.81	$549.54	$741.31
United Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $575.44 / $1,202.26	Professional		$338.84	$575.44	$1,202.26
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 $245.47 / $436.52 / $912.01	Professional	TC	$245.47	$436.52	$912.01
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $398.11 / $660.69	Professional		$346.74	$398.11	$660.69
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 $245.47 / $288.40 / $467.74	Professional	TC	$245.47	$288.40	$467.74