Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $218.78 / $426.58 / $758.58	Facility	26	$218.78	$426.58	$758.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $537.03 / $1,862.09	Professional		$398.11	$537.03	$1,862.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $199.53 / $346.74 / $812.83	Professional	26	$199.53	$346.74	$812.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $288.40 / $616.60	Professional	TC	$199.53	$288.40	$616.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $398.11 / $851.14	Professional		$380.19	$398.11	$851.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $251.19 / $457.09	Professional	26	$190.55	$251.19	$457.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $977.24 / $1,479.11	Professional		$616.60	$977.24	$1,479.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $275.42 / $457.09 / $676.08	Professional	26	$275.42	$457.09	$676.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $512.86 / $812.83	Professional	TC	$346.74	$512.86	$812.83
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $288.40 / $512.86 / $1,584.89	Facility	26	$288.40	$512.86	$1,584.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $1,047.13 / $1,348.96	Professional		$630.96	$1,047.13	$1,348.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $288.40 / $478.63 / $616.60	Professional	26	$288.40	$478.63	$616.60
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $562.34 / $741.31	Professional	TC	$354.81	$562.34	$741.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $354.81 / $426.58 / $446.68	Facility	26	$354.81	$426.58	$446.68
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $288.40 / $371.54 / $467.74	Professional	26	$288.40	$371.54	$467.74
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $446.68 / $575.44	Professional	TC	$346.74	$446.68	$575.44
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $295.12 / $295.12 / $309.03	Facility	26	$295.12	$295.12	$309.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $1,047.13 / $1,380.38	Professional		$645.65	$1,047.13	$1,380.38
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $309.03 / $501.19 / $660.69	Professional	26	$309.03	$501.19	$660.69
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $549.54 / $724.44	Professional	TC	$338.84	$549.54	$724.44
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 $302.00 / $467.74 / $630.96	Professional	26	$302.00	$467.74	$630.96
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $501.19 / $660.69	Professional	TC	$316.23	$501.19	$660.69
United Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $616.60 / $1,202.26	Professional		$426.58	$616.60	$1,202.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $199.53 / $288.40 / $575.44	Professional	26	$199.53	$288.40	$575.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $331.13 / $630.96	Professional	TC	$218.78	$331.13	$630.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $660.69 / $933.25	Professional		$489.78	$660.69	$933.25
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $229.09 / $309.03 / $436.52	Professional	26	$229.09	$309.03	$436.52
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $354.81 / $501.19	Professional	TC	$263.03	$354.81	$501.19