Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $30.20 / $83.18	Facility	26	$25.70	$30.20	$83.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $70.79 / $204.17	Professional		$30.90	$70.79	$204.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $46.77 / $134.90	Professional	26	$19.05	$46.77	$134.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $16.98 / $46.77 / $112.20	Professional	50	$16.98	$46.77	$112.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $8.91 / $33.11 / $93.33	Professional	TC	$8.91	$33.11	$93.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $117.49 / $147.91	Professional		$56.23	$117.49	$147.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $56.23 / $64.57	Professional	26	$24.55	$56.23	$64.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $53.70 / $58.88	Professional	TC	$53.70	$53.70	$58.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $53.70	Facility	26	$7.94	$37.15	$53.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $83.18 / $181.97	Professional		$38.02	$83.18	$181.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $43.65 / $95.50	Professional	26	$23.44	$43.65	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.88 / $39.81 / $93.33	Professional	TC	$12.88	$39.81	$93.33
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $48.98 / $229.09	Facility	26	$25.12	$48.98	$229.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $95.50 / $151.36	Professional		$40.74	$95.50	$151.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $46.77 / $79.43	Professional	26	$22.91	$46.77	$79.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $13.18 / $33.11 / $83.18	Professional	TC	$13.18	$33.11	$83.18
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 $39.81 / $53.70 / $64.57	Facility	26	$39.81	$53.70	$64.57
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $41.69 / $54.95	Professional	26	$28.18	$41.69	$54.95
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $13.80 / $21.38 / $61.66	Professional	TC	$13.80	$21.38	$61.66
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $30.90 / $44.67	Facility	26	$30.90	$30.90	$44.67
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $104.71 / $186.21	Professional		$70.79	$104.71	$186.21
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $69.18 / $97.72	Professional	26	$44.67	$69.18	$97.72
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $42.66 / $93.33	Professional	TC	$16.60	$42.66	$93.33
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 $66.07 / $117.49 / $165.96	Professional		$66.07	$117.49	$165.96
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $54.95 / $81.28	Professional	26	$31.62	$54.95	$81.28
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $60.26 / $91.20	Professional	TC	$19.95	$60.26	$91.20
United Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $57.54 / $123.03	Professional		$35.48	$57.54	$123.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $28.18 / $69.18	Professional	26	$22.39	$28.18	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $33.11 / $64.57	Professional	TC	$10.96	$33.11	$64.57
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $75.86 / $125.89	Professional		$66.07	$75.86	$125.89
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $37.15 / $61.66	Professional	26	$32.36	$37.15	$61.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $38.90 / $64.57	Professional	TC	$33.88	$38.90	$64.57