Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $114.82 / $208.93	Facility	26	$85.11	$114.82	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $575.44 / $2,137.96	Professional		$389.05	$575.44	$2,137.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $83.18 / $239.88	Professional	26	$67.61	$83.18	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $457.09 / $1,122.02	Professional	TC	$295.12	$457.09	$1,122.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $851.14 / $977.24	Professional		$831.76	$851.14	$977.24
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $134.90 / $151.36	Professional	26	$64.57	$134.90	$151.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $691.83 / $691.83	Professional	TC	$616.60	$691.83	$691.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $1,023.29 / $1,412.54	Professional		$602.56	$1,023.29	$1,412.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $158.49 / $245.47	Professional	26	$102.33	$158.49	$245.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $851.14 / $1,202.26	Professional	TC	$501.19	$851.14	$1,202.26
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $120.23 / $186.21 / $6,165.95	Facility	26	$120.23	$186.21	$6,165.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $1,071.52 / $1,412.54	Professional		$741.31	$1,071.52	$1,412.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $173.78 / $213.80	Professional	26	$120.23	$173.78	$213.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $891.25 / $1,202.26	Professional	TC	$630.96	$891.25	$1,202.26
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 $123.03 / $147.91 / $151.36	Facility	26	$123.03	$147.91	$151.36
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $141.25 / $165.96	Professional	26	$91.20	$141.25	$165.96
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $691.83 / $831.76	Professional	TC	$501.19	$691.83	$831.76
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $102.33 / $102.33	Facility	26	$102.33	$102.33	$102.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $1,000.00 / $1,230.27	Professional		$588.84	$1,000.00	$1,230.27
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $169.82 / $218.78	Professional	26	$102.33	$169.82	$218.78
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $831.76 / $1,000.00	Professional	TC	$489.78	$831.76	$1,000.00
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,511.89 / $2,511.89 / $2,511.89	Facility	26	$2,511.89	$2,511.89	$2,511.89
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 $104.71 / $162.18 / $218.78	Professional	26	$104.71	$162.18	$218.78
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $794.33 / $1,071.52	Professional	TC	$512.86	$794.33	$1,071.52
United Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $512.86 / $1,288.25	Professional		$380.19	$512.86	$1,288.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $85.11 / $213.80	Professional	26	$64.57	$85.11	$213.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $426.58 / $1,023.29	Professional	TC	$316.23	$426.58	$1,023.29
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $602.56 / $851.14	Professional		$512.86	$602.56	$851.14
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $102.33 / $144.54	Professional	26	$87.10	$102.33	$144.54
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $501.19 / $707.95	Professional	TC	$426.58	$501.19	$707.95