Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $407.38 / $1,000.00	Professional		$269.15	$407.38	$1,000.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $263.03 / $794.33	Professional	26	$87.10	$263.03	$794.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $331.13 / $741.31	Professional	TC	$173.78	$331.13	$741.31
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $234.42 / $275.42	Professional	26	$74.13	$234.42	$275.42
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $338.84 / $338.84	Professional	TC	$338.84	$338.84	$338.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $446.68 / $588.84	Professional		$204.17	$446.68	$588.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $144.54 / $204.17	Professional	26	$72.44	$144.54	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $302.00 / $398.11	Professional	TC	$128.82	$302.00	$398.11
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $194.98 / $338.84 / $3,630.78	Facility	26	$194.98	$338.84	$3,630.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $933.25 / $1,288.25	Professional		$489.78	$933.25	$1,288.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $288.40 / $389.05	Professional	26	$194.98	$288.40	$389.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $616.60 / $891.25	Professional	TC	$302.00	$616.60	$891.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $194.98	Professional		$32.36	$33.11	$194.98
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $275.42 / $288.40	Facility	26	$213.80	$275.42	$288.40
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $234.42 / $288.40	Professional	26	$169.82	$234.42	$288.40
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $363.08 / $588.84	Professional	TC	$269.15	$363.08	$588.84
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $977.24 / $1,202.26	Professional		$588.84	$977.24	$1,202.26
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $316.23 / $389.05	Professional	26	$194.98	$316.23	$389.05
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $660.69 / $812.83	Professional	TC	$398.11	$660.69	$812.83
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $776.25 / $1,000.00	Professional		$537.03	$776.25	$1,000.00
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $257.04 / $323.59	Professional	26	$194.98	$257.04	$323.59
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $524.81 / $676.08	Professional	TC	$302.00	$524.81	$676.08
United Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $363.08 / $870.96	Professional		$257.04	$363.08	$870.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $134.90 / $309.03	Professional	26	$83.18	$134.90	$309.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $194.98 / $562.34	Professional	TC	$165.96	$194.98	$562.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $426.58 / $426.58	Professional		$426.58	$426.58	$426.58
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $138.04 / $138.04	Professional	26	$138.04	$138.04	$138.04
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $295.12 / $295.12	Professional	TC	$295.12	$295.12	$295.12