Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $229.09 / $446.68	Facility	26	$138.04	$229.09	$446.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $537.03 / $2,570.40	Professional		$371.54	$537.03	$2,570.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $229.09 / $562.34	Professional	26	$114.82	$229.09	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $346.74 / $794.33	Professional	TC	$251.19	$346.74	$794.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $707.95 / $776.25	Professional		$630.96	$707.95	$776.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $208.93 / $323.59	Professional	26	$91.20	$208.93	$323.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $724.44 / $1,230.27	Professional		$371.54	$724.44	$1,230.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $181.97 / $354.81	Professional	26	$102.33	$181.97	$354.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $501.19 / $933.25	Professional	TC	$251.19	$501.19	$933.25
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $147.91 / $239.88 / $1,000.00	Facility	26	$147.91	$239.88	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $812.83 / $1,071.52	Professional		$467.74	$812.83	$1,071.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $223.87 / $309.03	Professional	26	$123.03	$223.87	$309.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $575.44 / $812.83	Professional	TC	$338.84	$575.44	$812.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $158.49	Professional		$32.36	$33.11	$158.49
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $239.88 / $245.47	Facility	26	$199.53	$239.88	$245.47
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $208.93 / $257.04	Professional	26	$147.91	$208.93	$257.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $489.78 / $812.83	Professional	TC	$346.74	$489.78	$812.83
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $162.18 / $165.96	Facility	26	$162.18	$162.18	$165.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $851.14 / $1,096.48	Professional		$512.86	$851.14	$1,096.48
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $263.03 / $354.81	Professional	26	$165.96	$263.03	$354.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $575.44 / $758.58	Professional	TC	$346.74	$575.44	$758.58
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 $537.03 / $794.33 / $1,071.52	Professional		$537.03	$794.33	$1,071.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $257.04 / $338.84	Professional	26	$169.82	$257.04	$338.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $562.34 / $741.31	Professional	TC	$371.54	$562.34	$741.31
United Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $549.54 / $1,148.15	Professional		$363.08	$549.54	$1,148.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $138.04 / $338.84	Professional	26	$104.71	$138.04	$338.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $398.11 / $794.33	Professional	TC	$251.19	$398.11	$794.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $436.52 / $724.44	Professional		$380.19	$436.52	$724.44
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $141.25 / $229.09	Professional	26	$123.03	$141.25	$229.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $295.12 / $489.78	Professional	TC	$257.04	$295.12	$489.78