Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $64.57 / $112.20	Facility	26	$44.67	$64.57	$112.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $309.03 / $954.99	Professional		$208.93	$309.03	$954.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $54.95 / $141.25	Professional	26	$34.67	$54.95	$141.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $245.47 / $707.95	Professional	TC	$177.83	$245.47	$707.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $489.78 / $794.33	Professional		$489.78	$489.78	$794.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $69.18 / $107.15	Professional	26	$35.48	$69.18	$107.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $588.84 / $891.25	Professional		$371.54	$588.84	$891.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $83.18 / $128.82	Professional	26	$53.70	$83.18	$128.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $501.19 / $776.25	Professional	TC	$323.59	$501.19	$776.25
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $100.00 / $1,819.70	Facility	26	$64.57	$100.00	$1,819.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $691.83 / $831.76	Professional		$478.63	$691.83	$831.76
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $93.33 / $114.82	Professional	26	$64.57	$93.33	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $588.84 / $724.44	Professional	TC	$416.87	$588.84	$724.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $77.62 / $81.28	Facility	26	$64.57	$77.62	$81.28
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $275.42	Professional		$275.42	$275.42	$275.42
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $72.44 / $85.11	Professional	26	$53.70	$72.44	$85.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $380.19 / $501.19	Professional	TC	$275.42	$380.19	$501.19
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $53.70 / $53.70	Facility	26	$53.70	$53.70	$53.70
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $630.96 / $776.25	Professional		$371.54	$630.96	$776.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $91.20 / $114.82	Professional	26	$53.70	$91.20	$114.82
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $537.03 / $660.69	Professional	TC	$316.23	$537.03	$660.69
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $724.44 / $724.44 / $724.44	Facility	26	$724.44	$724.44	$724.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $602.56 / $812.83	Professional		$389.05	$602.56	$812.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $85.11 / $114.82	Professional	26	$54.95	$85.11	$114.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $512.86 / $691.83	Professional	TC	$331.13	$512.86	$691.83
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $295.12 / $776.25	Professional		$204.17	$295.12	$776.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $43.65 / $112.20	Professional	26	$34.67	$43.65	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $239.88 / $676.08	Professional	TC	$169.82	$239.88	$676.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $363.08 / $512.86	Professional		$309.03	$363.08	$512.86
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $52.48 / $74.13	Professional	26	$44.67	$52.48	$74.13
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $316.23 / $436.52	Professional	TC	$269.15	$316.23	$436.52