Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $60.26 / $100.00	Facility	26	$30.90	$60.26	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $125.89 / $302.00	Professional		$85.11	$125.89	$302.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $30.90 / $97.72	Professional	26	$21.88	$30.90	$97.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $100.00 / $223.87	Professional	TC	$66.07	$100.00	$223.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Professional		$190.55	$190.55	$190.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $21.38 / $21.38	Professional	26	$21.38	$21.38	$21.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $181.97 / $398.11	Professional		$95.50	$181.97	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $44.67 / $83.18	Professional	26	$24.55	$44.67	$83.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $141.25 / $309.03	Professional	TC	$70.79	$141.25	$309.03
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $54.95 / $1,000.00	Facility	26	$30.90	$54.95	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $199.53 / $331.13	Professional		$102.33	$199.53	$331.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $48.98 / $70.79	Professional	26	$27.54	$48.98	$70.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $151.36 / $269.15	Professional	TC	$74.13	$151.36	$269.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $64.57	Professional		$32.36	$33.11	$64.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $54.95 / $56.23	Facility	26	$45.71	$54.95	$56.23
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $46.77 / $57.54	Professional	26	$33.11	$46.77	$57.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $123.03 / $186.21	Professional	TC	$85.11	$123.03	$186.21
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $38.02 / $38.02	Facility	26	$38.02	$38.02	$38.02
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $281.84 / $371.54	Professional		$177.83	$281.84	$371.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $61.66 / $83.18	Professional	26	$38.02	$61.66	$83.18
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $223.87 / $288.40	Professional	TC	$138.04	$223.87	$288.40
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 $186.21 / $257.04 / $371.54	Professional		$186.21	$257.04	$371.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $58.88 / $79.43	Professional	26	$39.81	$58.88	$79.43
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $204.17 / $295.12	Professional	TC	$138.04	$204.17	$295.12
United Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $131.83 / $323.59	Professional		$95.50	$131.83	$323.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $30.90 / $72.44	Professional	26	$24.55	$30.90	$72.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $100.00 / $251.19	Professional	TC	$72.44	$100.00	$251.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $158.49 / $263.03	Professional		$138.04	$158.49	$263.03
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $33.11 / $54.95	Professional	26	$28.84	$33.11	$54.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $125.89 / $208.93	Professional	TC	$109.65	$125.89	$208.93