Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $48.98 / $93.33	Facility	26	$30.20	$48.98	$93.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $109.65 / $295.12	Professional		$81.28	$109.65	$295.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $33.11 / $100.00	Professional	26	$22.91	$33.11	$100.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $77.62 / $169.82	Professional	TC	$56.23	$77.62	$169.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $41.69 / $42.66	Professional	26	$19.50	$41.69	$42.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $158.49 / $302.00	Professional		$83.18	$158.49	$302.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $41.69 / $77.62	Professional	26	$23.44	$41.69	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $114.82 / $229.09	Professional	TC	$58.88	$114.82	$229.09
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $50.12 / $275.42	Facility	26	$29.51	$50.12	$275.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $173.78 / $263.03	Professional		$93.33	$173.78	$263.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $47.86 / $66.07	Professional	26	$25.12	$47.86	$66.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $125.89 / $199.53	Professional	TC	$67.61	$125.89	$199.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $56.23	Professional		$32.36	$33.11	$56.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $51.29 / $52.48	Facility	26	$42.66	$51.29	$52.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $43.65 / $53.70	Professional	26	$30.90	$43.65	$53.70
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $112.20 / $147.91	Professional	TC	$79.43	$112.20	$147.91
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $35.48 / $35.48	Facility	26	$35.48	$35.48	$35.48
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $218.78 / $288.40	Professional		$138.04	$218.78	$288.40
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $58.88 / $77.62	Professional	26	$35.48	$58.88	$77.62
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $162.18 / $218.78	Professional	TC	$100.00	$162.18	$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 $138.04 / $199.53 / $281.84	Professional		$138.04	$199.53	$281.84
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 $102.33 / $147.91 / $208.93	Professional	TC	$102.33	$147.91	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $107.15 / $251.19	Professional		$83.18	$107.15	$251.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $29.51 / $69.18	Professional	26	$22.91	$29.51	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $79.43 / $181.97	Professional	TC	$60.26	$79.43	$181.97
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $117.49 / $194.98	Professional		$102.33	$117.49	$194.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $30.20 / $48.98	Professional	26	$26.30	$30.20	$48.98
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $87.10 / $144.54	Professional	TC	$75.86	$87.10	$144.54