Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $48.98 / $74.13	Facility	26	$34.67	$48.98	$74.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $141.25 / $331.13	Professional		$81.28	$141.25	$331.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $48.98 / $147.91	Professional	26	$22.91	$48.98	$147.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $100.00 / $257.04	Professional	TC	$61.66	$100.00	$257.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Professional		$109.65	$109.65	$109.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $13.49 / $22.91	Facility	26	$12.59	$13.49	$22.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $134.90 / $177.83	Professional		$46.77	$134.90	$177.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $33.11 / $43.65	Professional	26	$13.49	$33.11	$43.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $100.00 / $138.04	Professional	TC	$33.88	$100.00	$138.04
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $63.10 / $89.13	Facility	26	$36.31	$63.10	$89.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $275.42 / $380.19	Professional		$138.04	$275.42	$380.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $66.07 / $89.13	Professional	26	$38.02	$66.07	$89.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $213.80 / $281.84	Professional	TC	$100.00	$213.80	$281.84
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 $53.70 / $64.57 / $67.61	Facility	26	$53.70	$64.57	$67.61
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $53.70 / $72.44	Professional	26	$40.74	$53.70	$72.44
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $162.18 / $194.98	Professional	TC	$123.03	$162.18	$194.98
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $44.67 / $44.67	Facility	26	$44.67	$44.67	$44.67
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $302.00 / $380.19	Professional		$181.97	$302.00	$380.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $74.13 / $95.50	Professional	26	$44.67	$74.13	$95.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $229.09 / $281.84	Professional	TC	$138.04	$229.09	$281.84
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $251.19 / $331.13	Professional		$154.88	$251.19	$331.13
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $60.26 / $81.28	Professional	26	$43.65	$60.26	$81.28
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $186.21 / $245.47	Professional	TC	$112.20	$186.21	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $85.11 / $213.80	Professional		$61.66	$85.11	$213.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $21.88 / $69.18	Professional	26	$16.98	$21.88	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $63.10 / $165.96	Professional	TC	$43.65	$63.10	$165.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $177.83 / $251.19	Professional		$131.83	$177.83	$251.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $43.65 / $61.66	Professional	26	$32.36	$43.65	$61.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $134.90 / $190.55	Professional	TC	$100.00	$134.90	$190.55