Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $144.54 / $281.84	Facility	26	$87.10	$144.54	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $501.19 / $1,348.96	Professional		$251.19	$501.19	$1,348.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $141.25 / $398.11	Professional	26	$77.62	$141.25	$398.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $338.84 / $707.95	Professional	TC	$245.47	$338.84	$707.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $616.60 / $954.99	Professional		$223.87	$616.60	$954.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $120.23 / $141.25	Professional	26	$57.54	$120.23	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $630.96 / $1,047.13	Professional		$323.59	$630.96	$1,047.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $114.82 / $229.09	Professional	26	$64.57	$114.82	$229.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $489.78 / $870.96	Professional	TC	$245.47	$489.78	$870.96
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $151.36 / $1,584.89	Facility	26	$87.10	$151.36	$1,584.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $724.44 / $933.25	Professional		$416.87	$724.44	$933.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $141.25 / $194.98	Professional	26	$75.86	$141.25	$194.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $562.34 / $758.58	Professional	TC	$331.13	$562.34	$758.58
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 $125.89 / $151.36 / $154.88	Facility	26	$125.89	$151.36	$154.88
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $426.58 / $457.09	Professional		$426.58	$426.58	$457.09
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $141.25 / $169.82	Professional	26	$93.33	$141.25	$169.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $524.81 / $794.33	Professional	TC	$354.81	$524.81	$794.33
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $104.71 / $104.71	Facility	26	$104.71	$104.71	$104.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $724.44 / $933.25	Professional		$446.68	$724.44	$933.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $165.96 / $223.87	Professional	26	$104.71	$165.96	$223.87
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $562.34 / $724.44	Professional	TC	$338.84	$562.34	$724.44
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,380.38 / $1,380.38 / $1,380.38	Facility	26	$1,380.38	$1,380.38	$1,380.38
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $707.95 / $933.25	Professional		$457.09	$707.95	$933.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $162.18 / $213.80	Professional	26	$107.15	$162.18	$213.80
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $549.54 / $707.95	Professional	TC	$354.81	$549.54	$707.95
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $457.09 / $1,000.00	Professional		$316.23	$457.09	$1,000.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $87.10 / $213.80	Professional	26	$66.07	$87.10	$213.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $380.19 / $776.25	Professional	TC	$245.47	$380.19	$776.25
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 $75.86 / $87.10 / $144.54	Professional	26	$75.86	$87.10	$144.54
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $288.40 / $478.63	Professional	TC	$251.19	$288.40	$478.63