Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $120.23 / $229.09	Facility	26	$75.86	$120.23	$229.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $380.19 / $776.25	Professional		$229.09	$380.19	$776.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $72.44 / $245.47	Professional	26	$52.48	$72.44	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $281.84 / $602.56	Professional	TC	$186.21	$281.84	$602.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Professional	26	$100.00	$100.00	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $724.44 / $1,023.29	Professional		$436.52	$724.44	$1,023.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $134.90 / $208.93	Professional	26	$87.10	$134.90	$208.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $549.54 / $831.76	Professional	TC	$346.74	$549.54	$831.76
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $158.49 / $6,165.95	Facility	26	$102.33	$158.49	$6,165.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $776.25 / $1,000.00	Professional		$537.03	$776.25	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $144.54 / $181.97	Professional	26	$102.33	$144.54	$181.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $436.52 / $616.60 / $831.76	Professional	TC	$436.52	$616.60	$831.76
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 $104.71 / $125.89 / $128.82	Facility	26	$104.71	$125.89	$128.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $117.49 / $151.36	Professional	26	$87.10	$117.49	$151.36
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $467.74 / $602.56	Professional	TC	$363.08	$467.74	$602.56
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $85.11 / $87.10	Facility	26	$85.11	$85.11	$87.10
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $724.44 / $891.25	Professional		$426.58	$724.44	$891.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $144.54 / $181.97	Professional	26	$87.10	$144.54	$181.97
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $575.44 / $707.95	Professional	TC	$338.84	$575.44	$707.95
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,511.89 / $2,511.89 / $2,511.89	Facility	26	$2,511.89	$2,511.89	$2,511.89
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $691.83 / $933.25	Professional		$446.68	$691.83	$933.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $134.90 / $181.97	Professional	26	$87.10	$134.90	$181.97
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $549.54 / $741.31	Professional	TC	$354.81	$549.54	$741.31
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $363.08 / $933.25	Professional		$269.15	$363.08	$933.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $72.44 / $177.83	Professional	26	$54.95	$72.44	$177.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $288.40 / $724.44	Professional	TC	$213.80	$288.40	$724.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $436.52 / $616.60	Professional		$371.54	$436.52	$616.60
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $87.10 / $123.03	Professional	26	$74.13	$87.10	$123.03
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $354.81 / $501.19	Professional	TC	$302.00	$354.81	$501.19