Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $44.67 / $89.13	Facility	26	$26.92	$44.67	$89.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $81.28 / $288.40	Professional		$38.90	$81.28	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $42.66 / $134.90	Professional	26	$19.95	$42.66	$134.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $25.12 / $95.50	Professional	TC	$16.98	$25.12	$95.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $47.86 / $79.43	Professional		$43.65	$47.86	$79.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $40.74 / $43.65	Professional	26	$17.38	$40.74	$43.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.75 / $26.92 / $38.02	Facility	26	$5.75	$26.92	$38.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $81.28 / $141.25	Professional		$46.77	$81.28	$141.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $38.90 / $70.79	Professional	26	$24.55	$38.90	$70.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $39.81 / $70.79	Professional	TC	$21.38	$39.81	$70.79
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $46.77 / $288.40	Facility	26	$28.18	$46.77	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $87.10 / $120.23	Professional		$48.98	$87.10	$120.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $44.67 / $60.26	Professional	26	$26.30	$44.67	$60.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $41.69 / $58.88	Professional	TC	$20.42	$41.69	$58.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $32.36 / $33.11	Professional		$28.84	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $46.77 / $48.98	Facility	26	$38.90	$46.77	$48.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $40.74 / $50.12	Professional	26	$28.84	$40.74	$50.12
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $36.31 / $45.71	Professional	TC	$26.92	$36.31	$45.71
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $32.36 / $32.36	Facility	26	$32.36	$32.36	$32.36
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $100.00 / $131.83	Professional		$61.66	$100.00	$131.83
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $52.48 / $67.61	Professional	26	$32.36	$52.48	$67.61
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $48.98 / $66.07	Professional	TC	$29.51	$48.98	$66.07
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 $61.66 / $91.20 / $125.89	Professional		$61.66	$91.20	$125.89
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $47.86 / $66.07	Professional	26	$33.11	$47.86	$66.07
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $42.66 / $58.88	Professional	TC	$29.51	$42.66	$58.88
United Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $53.70 / $114.82	Professional		$44.67	$53.70	$114.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $26.92 / $60.26	Professional	26	$24.55	$26.92	$60.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $25.70 / $57.54	Professional	TC	$21.38	$25.70	$57.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $53.70 / $89.13	Professional		$46.77	$53.70	$89.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $28.18 / $46.77	Professional	26	$24.55	$28.18	$46.77
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $25.12 / $41.69	Professional	TC	$21.88	$25.12	$41.69