Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $147.91 / $316.23 / $512.86	Facility	26	$147.91	$316.23	$512.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $457.09 / $1,071.52	Professional		$316.23	$457.09	$1,071.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $154.88 / $346.74	Professional	26	$128.82	$154.88	$346.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $288.40 / $630.96	Professional	TC	$186.21	$288.40	$630.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $851.14 / $1,479.11	Professional		$467.74	$851.14	$1,479.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $186.21 / $309.03 / $457.09	Professional	26	$186.21	$309.03	$457.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $575.44 / $977.24	Professional	TC	$275.42	$575.44	$977.24
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $194.98 / $346.74 / $1,584.89	Facility	26	$194.98	$346.74	$1,584.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $851.14 / $1,202.26	Professional		$512.86	$851.14	$1,202.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $316.23 / $416.87	Professional	26	$194.98	$316.23	$416.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $537.03 / $831.76	Professional	TC	$302.00	$537.03	$831.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $245.47 / $288.40 / $302.00	Facility	26	$245.47	$288.40	$302.00
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $251.19 / $302.00	Professional	26	$181.97	$251.19	$302.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $512.86 / $616.60	Professional	TC	$281.84	$512.86	$616.60
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $199.53 / $208.93	Facility	26	$199.53	$199.53	$208.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $1,023.29 / $1,348.96	Professional		$630.96	$1,023.29	$1,348.96
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $208.93 / $338.84 / $446.68	Professional	26	$208.93	$338.84	$446.68
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $676.08 / $912.01	Professional	TC	$426.58	$676.08	$912.01
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $660.69 / $660.69 / $660.69	Facility	26	$660.69	$660.69	$660.69
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $954.99 / $1,288.25	Professional		$616.60	$954.99	$1,288.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $316.23 / $426.58	Professional	26	$204.17	$316.23	$426.58
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $407.38 / $630.96 / $851.14	Professional	TC	$407.38	$630.96	$851.14
United Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $524.81 / $1,122.02	Professional		$331.13	$524.81	$1,122.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $194.98 / $389.05	Professional	26	$134.90	$194.98	$389.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $323.59 / $707.95	Professional	TC	$218.78	$323.59	$707.95
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $645.65 / $912.01	Professional		$478.63	$645.65	$912.01
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $208.93 / $295.12	Professional	26	$154.88	$208.93	$295.12
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $436.52 / $616.60	Professional	TC	$323.59	$436.52	$616.60