Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $57.54 / $95.50	Facility	26	$43.65	$57.54	$95.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $123.03 / $288.40	Professional		$79.43	$123.03	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $30.20 / $83.18	Professional	26	$21.88	$30.20	$83.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $104.71 / $239.88	Professional	TC	$69.18	$104.71	$239.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $33.88 / $33.88	Professional	26	$33.88	$33.88	$33.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $144.54 / $144.54	Professional	TC	$144.54	$144.54	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $190.55 / $398.11	Professional		$100.00	$190.55	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $42.66 / $77.62	Professional	26	$23.99	$42.66	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $147.91 / $323.59	Professional	TC	$74.13	$147.91	$323.59
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $51.29 / $851.14	Facility	26	$29.51	$51.29	$851.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $199.53 / $338.84	Professional		$100.00	$199.53	$338.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $47.86 / $67.61	Professional	26	$25.70	$47.86	$67.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $151.36 / $281.84	Professional	TC	$75.86	$151.36	$281.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $69.18	Professional		$32.36	$33.11	$69.18
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $52.48 / $52.48	Facility	26	$43.65	$52.48	$52.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $45.71 / $56.23	Professional	26	$31.62	$45.71	$56.23
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $128.82 / $204.17	Professional	TC	$93.33	$128.82	$204.17
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $36.31 / $36.31	Facility	26	$36.31	$36.31	$36.31
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $288.40 / $380.19	Professional		$181.97	$288.40	$380.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $58.88 / $79.43	Professional	26	$36.31	$58.88	$79.43
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $234.42 / $309.03	Professional	TC	$144.54	$234.42	$309.03
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $707.95 / $707.95 / $707.95	Facility	26	$707.95	$707.95	$707.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $263.03 / $371.54	Professional		$181.97	$263.03	$371.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $56.23 / $74.13	Professional	26	$37.15	$56.23	$74.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $208.93 / $295.12	Professional	TC	$141.25	$208.93	$295.12
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $134.90 / $316.23	Professional		$100.00	$134.90	$316.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $29.51 / $69.18	Professional	26	$23.99	$29.51	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $104.71 / $251.19	Professional	TC	$75.86	$104.71	$251.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $162.18 / $269.15	Professional		$141.25	$162.18	$269.15
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $30.90 / $51.29	Professional	26	$26.92	$30.90	$51.29
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $131.83 / $213.80	Professional	TC	$114.82	$131.83	$213.80