Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $37.15 / $74.13	Facility	26	$30.90	$37.15	$74.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $91.20 / $426.58	Professional		$51.29	$91.20	$426.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $38.02 / $128.82	Professional	26	$22.91	$38.02	$128.82
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $38.02 / $89.13 / $371.54	Professional	52	$38.02	$89.13	$371.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $52.48 / $194.98	Professional	TC	$25.12	$52.48	$194.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $107.15 / $177.83	Professional		$43.65	$107.15	$177.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $46.77 / $51.29	Professional	26	$19.95	$46.77	$51.29
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $117.49 / $117.49 / $141.25	Professional	52	$117.49	$117.49	$141.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.61 / $30.90 / $44.67	Facility	26	$6.61	$30.90	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $117.49 / $194.98	Professional		$74.13	$117.49	$194.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $44.67 / $79.43	Professional	26	$26.92	$44.67	$79.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $69.18 / $125.89	Professional	TC	$39.81	$69.18	$125.89
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $51.29 / $288.40	Facility	26	$30.20	$51.29	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $134.90 / $194.98	Professional		$89.13	$134.90	$194.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $50.12 / $70.79	Professional	26	$29.51	$50.12	$70.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $81.28 / $138.04	Professional	TC	$56.23	$81.28	$138.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $52.48 / $54.95	Facility	26	$43.65	$52.48	$54.95
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Professional		$93.33	$93.33	$93.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $46.77 / $56.23	Professional	26	$35.48	$46.77	$56.23
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $89.13 / $117.49	Professional	TC	$53.70	$89.13	$117.49
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $36.31 / $37.15	Facility	26	$36.31	$36.31	$37.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $128.82 / $173.78	Professional		$77.62	$128.82	$173.78
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $60.26 / $83.18	Professional	26	$36.31	$60.26	$83.18
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $69.18 / $100.00	Professional	TC	$41.69	$69.18	$100.00
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 $81.28 / $123.03 / $173.78	Professional		$81.28	$123.03	$173.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $54.95 / $75.86	Professional	26	$38.02	$54.95	$75.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $66.07 / $104.71	Professional	TC	$42.66	$66.07	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $89.13 / $177.83	Professional		$63.10	$89.13	$177.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $29.51 / $70.79	Professional	26	$26.30	$29.51	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $58.88 / $112.20	Professional	TC	$33.88	$58.88	$112.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $72.44 / $120.23	Professional		$63.10	$72.44	$120.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $32.36 / $53.70	Professional	26	$28.18	$32.36	$53.70
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $40.74 / $66.07	Professional	TC	$34.67	$40.74	$66.07