Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $46.77 / $91.20	Facility	26	$37.15	$46.77	$91.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $151.36 / $630.96	Professional		$87.10	$151.36	$630.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $53.70 / $162.18	Professional	26	$28.84	$53.70	$162.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $95.50 / $407.38	Professional	TC	$61.66	$95.50	$407.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $125.89 / $218.78	Professional		$75.86	$125.89	$218.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $52.48 / $60.26	Professional	26	$23.99	$52.48	$60.26
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $144.54 / $169.82	Professional	TC	$109.65	$144.54	$169.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $52.48	Facility	26	$7.94	$37.15	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $181.97 / $331.13	Professional		$107.15	$181.97	$331.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $54.95 / $95.50	Professional	26	$33.88	$54.95	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $125.89 / $234.42	Professional	TC	$72.44	$125.89	$234.42
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $63.10 / $323.59	Facility	26	$38.02	$63.10	$323.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $208.93 / $295.12	Professional		$131.83	$208.93	$295.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $61.66 / $83.18	Professional	26	$37.15	$61.66	$83.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $147.91 / $208.93	Professional	TC	$93.33	$147.91	$208.93
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 $52.48 / $64.57 / $66.07	Facility	26	$52.48	$64.57	$66.07
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Professional		$109.65	$109.65	$109.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $57.54 / $67.61	Professional	26	$39.81	$57.54	$67.61
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $128.82 / $173.78	Professional	TC	$95.50	$128.82	$173.78
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $43.65 / $44.67	Facility	26	$43.65	$43.65	$44.67
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $234.42 / $302.00	Professional		$144.54	$234.42	$302.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $72.44 / $97.72	Professional	26	$43.65	$72.44	$97.72
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $165.96 / $218.78	Professional	TC	$100.00	$165.96	$218.78
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $213.80 / $295.12	Professional		$147.91	$213.80	$295.12
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $66.07 / $89.13	Professional	26	$45.71	$66.07	$89.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $151.36 / $204.17	Professional	TC	$102.33	$151.36	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $125.89 / $275.42	Professional		$107.15	$125.89	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $36.31 / $85.11	Professional	26	$33.11	$36.31	$85.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $87.10 / $190.55	Professional	TC	$72.44	$87.10	$190.55
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $125.89 / $208.93	Professional		$109.65	$125.89	$208.93
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $38.02 / $63.10	Professional	26	$33.11	$38.02	$63.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $87.10 / $144.54	Professional	TC	$75.86	$87.10	$144.54