Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $251.19 / $512.86	Facility	26	$162.18	$251.19	$512.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $1,047.13 / $3,981.07	Professional		$724.44	$1,047.13	$3,981.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $208.93 / $812.83	Professional	26	$109.65	$208.93	$812.83
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $154.88 / $1,071.52 / $1,479.11	Professional	52	$154.88	$1,071.52	$1,479.11
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $549.54 / $549.54 / $549.54	Professional	53	$549.54	$549.54	$549.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $758.58 / $1,513.56	Professional	TC	$588.84	$758.58	$1,513.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $691.83 / $1,122.02	Professional		$588.84	$691.83	$1,122.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $91.20 / $91.20	Professional	26	$91.20	$91.20	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,348.96 / $2,398.83	Professional		$794.33	$1,348.96	$2,398.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $213.80 / $380.19	Professional	26	$125.89	$213.80	$380.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $660.69 / $1,122.02 / $2,041.74	Professional	TC	$660.69	$1,122.02	$2,041.74
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $263.03 / $2,238.72	Facility	26	$162.18	$263.03	$2,238.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $1,513.56 / $2,089.30	Professional		$912.01	$1,513.56	$2,089.30
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $245.47 / $331.13	Professional	26	$147.91	$245.47	$331.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $776.25 / $1,288.25 / $1,778.28	Professional	TC	$776.25	$1,288.25	$1,778.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $398.11	Professional		$32.36	$33.11	$398.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $181.97 / $218.78 / $354.81	Facility	26	$181.97	$218.78	$354.81
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $489.78 / $489.78	Professional		$489.78	$489.78	$489.78
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $275.42 / $354.81	Professional	26	$158.49	$275.42	$354.81
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $831.76 / $1,122.02 / $1,548.82	Professional	TC	$831.76	$1,122.02	$1,548.82
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $151.36 / $151.36 / $151.36	Facility	26	$151.36	$151.36	$151.36
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,584.89 / $2,137.96	Professional		$1,023.29	$1,584.89	$2,137.96
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $251.19 / $323.59	Professional	26	$151.36	$251.19	$323.59
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $870.96 / $1,318.26 / $1,819.70	Professional	TC	$870.96	$1,318.26	$1,819.70
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,584.89 / $1,584.89 / $1,584.89	Facility	26	$1,584.89	$1,584.89	$1,584.89
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,513.56 / $1,949.84	Professional		$1,071.52	$1,513.56	$1,949.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $218.78 / $323.59	Professional	26	$154.88	$218.78	$323.59
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $933.25 / $1,288.25 / $1,659.59	Professional	TC	$933.25	$1,288.25	$1,659.59
United Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,288.25 / $2,187.76	Professional		$831.76	$1,288.25	$2,187.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $229.09 / $354.81	Professional	26	$131.83	$229.09	$354.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $1,071.52 / $1,819.70	Professional	TC	$691.83	$1,071.52	$1,819.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $977.24 / $1,584.89	Professional		$831.76	$977.24	$1,584.89
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $138.04 / $229.09	Professional	26	$120.23	$138.04	$229.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $724.44 / $831.76 / $1,380.38	Professional	TC	$724.44	$831.76	$1,380.38