Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $56.23 / $97.72	Facility	26	$38.90	$56.23	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $128.82 / $436.52	Professional		$75.86	$128.82	$436.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $46.77 / $151.36	Professional	26	$28.84	$46.77	$151.36
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $46.77 / $234.42 / $776.25	Professional	50	$46.77	$234.42	$776.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $74.13 / $181.97	Professional	TC	$54.95	$74.13	$181.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $190.55 / $234.42	Professional		$70.79	$190.55	$234.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $91.20 / $100.00	Professional	26	$25.70	$91.20	$100.00
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $104.71 / $251.19 / $354.81	Professional	50	$104.71	$251.19	$354.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.51 / $39.81 / $56.23	Facility	26	$8.51	$39.81	$56.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $177.83 / $323.59	Professional		$104.71	$177.83	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $57.54 / $102.33	Professional	26	$36.31	$57.54	$102.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $117.49 / $218.78	Professional	TC	$67.61	$117.49	$218.78
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $67.61 / $323.59	Facility	26	$39.81	$67.61	$323.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $199.53 / $281.84	Professional		$117.49	$199.53	$281.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $66.07 / $89.13	Professional	26	$39.81	$66.07	$89.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $131.83 / $194.98	Professional	TC	$79.43	$131.83	$194.98
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 $56.23 / $69.18 / $69.18	Facility	26	$56.23	$69.18	$69.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $56.23 / $74.13	Professional	26	$41.69	$56.23	$74.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $117.49 / $144.54	Professional	TC	$91.20	$117.49	$144.54
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $46.77 / $46.77 / $46.77	Facility	26	$46.77	$46.77	$46.77
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $229.09 / $295.12	Professional		$141.25	$229.09	$295.12
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $77.62 / $104.71	Professional	26	$46.77	$77.62	$104.71
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $154.88 / $204.17	Professional	TC	$93.33	$154.88	$204.17
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 $144.54 / $208.93 / $288.40	Professional		$144.54	$208.93	$288.40
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $70.79 / $95.50	Professional	26	$47.86	$70.79	$95.50
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $138.04 / $190.55	Professional	TC	$95.50	$138.04	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $117.49 / $263.03	Professional		$104.71	$117.49	$263.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $38.90 / $89.13	Professional	26	$35.48	$38.90	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $77.62 / $173.78	Professional	TC	$67.61	$77.62	$173.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $120.23 / $199.53	Professional		$104.71	$120.23	$199.53
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $38.90 / $64.57	Professional	26	$33.88	$38.90	$64.57
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $81.28 / $131.83	Professional	TC	$69.18	$81.28	$131.83