Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $61.66 / $112.20	Facility	26	$31.62	$61.66	$112.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $144.54 / $1,047.13	Professional		$63.10	$144.54	$1,047.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $190.55 / $851.14	Professional	26	$33.11	$190.55	$851.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $43.65 / $141.25	Professional	TC	$26.92	$43.65	$141.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $67.61 / $147.91	Professional		$52.48	$67.61	$147.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $36.31 / $66.07	Professional	26	$26.92	$36.31	$66.07
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $29.51 / $29.51	Professional	TC	$29.51	$29.51	$29.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $134.90 / $208.93	Professional		$81.28	$134.90	$208.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $64.57 / $97.72	Professional	26	$39.81	$64.57	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $70.79 / $109.65	Professional	TC	$41.69	$70.79	$109.65
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $74.13 / $588.84	Facility	26	$41.69	$74.13	$588.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $141.25 / $190.55	Professional		$85.11	$141.25	$190.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $69.18 / $89.13	Professional	26	$41.69	$69.18	$89.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $75.86 / $102.33	Professional	TC	$43.65	$75.86	$102.33
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 $52.48 / $61.66 / $64.57	Facility	26	$52.48	$61.66	$64.57
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $57.54	Professional		$57.54	$57.54	$57.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $53.70 / $67.61	Professional	26	$41.69	$53.70	$67.61
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $56.23 / $72.44	Professional	TC	$45.71	$56.23	$72.44
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $42.66 / $44.67	Facility	26	$42.66	$42.66	$44.67
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $147.91 / $194.98	Professional		$91.20	$147.91	$194.98
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $72.44 / $95.50	Professional	26	$44.67	$72.44	$95.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $75.86 / $100.00	Professional	TC	$45.71	$75.86	$100.00
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $245.47 / $245.47 / $245.47	Facility	26	$245.47	$245.47	$245.47
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $134.90 / $186.21	Professional		$89.13	$134.90	$186.21
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $67.61 / $91.20	Professional	26	$43.65	$67.61	$91.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $69.18 / $93.33	Professional	TC	$44.67	$69.18	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $85.11 / $173.78	Professional		$61.66	$85.11	$173.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $41.69 / $85.11	Professional	26	$28.18	$41.69	$85.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $44.67 / $85.11	Professional	TC	$34.67	$44.67	$85.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $93.33 / $131.83	Professional		$69.18	$93.33	$131.83
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $44.67 / $63.10	Professional	26	$33.11	$44.67	$63.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $48.98 / $69.18	Professional	TC	$36.31	$48.98	$69.18