Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $102.33 / $199.53	Facility	26	$61.66	$102.33	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $269.15 / $645.65	Professional		$131.83	$269.15	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $79.43 / $204.17	Professional	26	$51.29	$79.43	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $208.93 / $436.52	Professional	TC	$141.25	$208.93	$436.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $87.10 / $100.00	Professional	26	$40.74	$87.10	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $371.54 / $660.69	Professional		$204.17	$371.54	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $81.28 / $162.18	Professional	26	$45.71	$81.28	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $281.84 / $501.19	Professional	TC	$151.36	$281.84	$501.19
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $107.15 / $1,000.00	Facility	26	$63.10	$107.15	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $426.58 / $562.34	Professional		$239.88	$426.58	$562.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $100.00 / $138.04	Professional	26	$53.70	$100.00	$138.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $323.59 / $436.52	Professional	TC	$190.55	$323.59	$436.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $95.50	Professional		$32.36	$33.11	$95.50
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $107.15 / $112.20	Facility	26	$89.13	$107.15	$112.20
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $251.19 / $251.19	Professional		$251.19	$251.19	$251.19
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $97.72 / $123.03	Professional	26	$64.57	$97.72	$123.03
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $302.00 / $416.87	Professional	TC	$186.21	$302.00	$416.87
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $74.13 / $74.13	Facility	26	$74.13	$74.13	$74.13
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $467.74 / $602.56	Professional		$281.84	$467.74	$602.56
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $117.49 / $158.49	Professional	26	$74.13	$117.49	$158.49
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $338.84 / $446.68	Professional	TC	$208.93	$338.84	$446.68
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 $288.40 / $436.52 / $588.84	Professional		$288.40	$436.52	$588.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $114.82 / $151.36	Professional	26	$77.62	$114.82	$151.36
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $331.13 / $436.52	Professional	TC	$213.80	$331.13	$436.52
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $269.15 / $588.84	Professional		$190.55	$269.15	$588.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $61.66 / $144.54	Professional	26	$46.77	$61.66	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $199.53 / $436.52	Professional	TC	$141.25	$199.53	$436.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $239.88 / $398.11	Professional		$208.93	$239.88	$398.11
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $61.66 / $102.33	Professional	26	$53.70	$61.66	$102.33
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $177.83 / $288.40	Professional	TC	$154.88	$177.83	$288.40