Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $190.55 / $309.03	Facility	26	$100.00	$190.55	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $501.19 / $2,187.76	Professional		$346.74	$501.19	$2,187.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $141.25 / $398.11	Professional	26	$85.11	$141.25	$398.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $363.08 / $794.33	Professional	TC	$257.04	$363.08	$794.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $234.42 / $234.42	Professional		$234.42	$234.42	$234.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $645.65 / $1,122.02	Professional		$346.74	$645.65	$1,122.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $125.89 / $245.47	Professional	26	$70.79	$125.89	$245.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $512.86 / $891.25	Professional	TC	$263.03	$512.86	$891.25
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $158.49 / $213.80	Facility	26	$97.72	$158.49	$213.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $758.58 / $1,000.00	Professional		$436.52	$758.58	$1,000.00
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 $354.81 / $588.84 / $794.33	Professional	TC	$354.81	$588.84	$794.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $165.96	Professional		$32.36	$33.11	$165.96
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $165.96 / $169.82	Facility	26	$138.04	$165.96	$169.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $151.36 / $177.83	Professional	26	$102.33	$151.36	$177.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $562.34 / $794.33	Professional	TC	$371.54	$562.34	$794.33
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 $478.63 / $776.25 / $1,000.00	Professional		$478.63	$776.25	$1,000.00
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 $363.08 / $588.84 / $776.25	Professional	TC	$363.08	$588.84	$776.25
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 $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 $371.54 / $575.44 / $758.58	Professional	TC	$371.54	$575.44	$758.58
United Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $467.74 / $1,047.13	Professional		$331.13	$467.74	$1,047.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $95.50 / $234.42	Professional	26	$72.44	$95.50	$234.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $380.19 / $812.83	Professional	TC	$257.04	$380.19	$812.83
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 $83.18 / $95.50 / $158.49	Professional	26	$83.18	$95.50	$158.49
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $309.03 / $501.19	Professional	TC	$269.15	$309.03	$501.19