Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $45.71 / $79.43	Facility	26	$32.36	$45.71	$79.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $61.66 / $213.80	Professional		$45.71	$61.66	$213.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $43.65 / $117.49	Professional	26	$25.70	$43.65	$117.49
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $25.70 / $47.86 / $257.04	Professional	52	$25.70	$47.86	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $28.84 / $104.71	Professional	TC	$19.95	$28.84	$104.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $74.13 / $112.20	Professional		$46.77	$74.13	$112.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $43.65 / $54.95	Professional	26	$20.89	$43.65	$54.95
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $21.88 / $28.18 / $36.31	Professional	52	$21.88	$28.18	$36.31
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $45.71 / $54.95	Professional	TC	$26.92	$45.71	$54.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $85.11 / $158.49	Professional		$46.77	$85.11	$158.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $45.71 / $83.18	Professional	26	$25.70	$45.71	$83.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $39.81 / $74.13	Professional	TC	$21.38	$39.81	$74.13
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $56.23 / $87.10	Facility	26	$33.11	$56.23	$87.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $97.72 / $138.04	Professional		$53.70	$97.72	$138.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $52.48 / $72.44	Professional	26	$28.18	$52.48	$72.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $45.71 / $64.57	Professional	TC	$25.70	$45.71	$64.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $56.23 / $57.54	Facility	26	$45.71	$56.23	$57.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $47.86 / $63.10	Professional	26	$34.67	$47.86	$63.10
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $42.66 / $52.48	Professional	TC	$33.11	$42.66	$52.48
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $38.02 / $38.90	Facility	26	$38.02	$38.02	$38.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $114.82 / $151.36	Professional		$70.79	$114.82	$151.36
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $61.66 / $83.18	Professional	26	$38.02	$61.66	$83.18
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $52.48 / $69.18	Professional	TC	$33.11	$52.48	$69.18
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $48.98 / $48.98	Facility	26	$48.98	$48.98	$48.98
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $109.65 / $147.91	Professional		$72.44	$109.65	$147.91
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $60.26 / $79.43	Professional	26	$39.81	$60.26	$79.43
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $50.12 / $67.61	Professional	TC	$33.88	$50.12	$67.61
United Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $66.07 / $138.04	Professional		$50.12	$66.07	$138.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $35.48 / $74.13	Professional	26	$25.70	$35.48	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $29.51 / $61.66	Professional	TC	$22.91	$29.51	$61.66
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $60.26 / $100.00	Professional		$52.48	$60.26	$100.00
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 $24.55 / $28.18 / $46.77	Professional	TC	$24.55	$28.18	$46.77