Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $54.95 / $123.03	Professional		$33.88	$54.95	$123.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $53.70 / $245.47	Professional	26	$26.92	$53.70	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $20.89 / $39.81	Professional	TC	$10.96	$20.89	$39.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $38.90 / $60.26	Professional	26	$17.78	$38.90	$60.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $56.23 / $79.43	Professional		$28.84	$56.23	$79.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $36.31 / $52.48	Professional	26	$19.05	$36.31	$52.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $8.91 / $19.95 / $25.70	Professional	TC	$8.91	$19.95	$25.70
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $75.86 / $100.00	Facility	26	$47.86	$75.86	$100.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $128.82 / $162.18	Professional		$79.43	$128.82	$162.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $75.86 / $102.33	Professional	26	$51.29	$75.86	$102.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $42.66 / $64.57	Professional	TC	$23.99	$42.66	$64.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $32.36 / $33.11	Professional		$23.44	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $72.44 / $75.86	Facility	26	$54.95	$72.44	$75.86
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $63.10 / $83.18	Professional	26	$44.67	$63.10	$83.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $33.11 / $45.71	Professional	TC	$24.55	$33.11	$45.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $123.03 / $154.88	Professional		$77.62	$123.03	$154.88
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $81.28 / $100.00	Professional	26	$50.12	$81.28	$100.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $43.65 / $53.70	Professional	TC	$26.92	$43.65	$53.70
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $102.33 / $128.82	Professional		$75.86	$102.33	$128.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $66.07 / $83.18	Professional	26	$50.12	$66.07	$83.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $36.31 / $48.98	Professional	TC	$25.70	$36.31	$48.98
United Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $53.70 / $117.49	Professional		$33.11	$53.70	$117.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $34.67 / $81.28	Professional	26	$21.38	$34.67	$81.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.72 / $18.20 / $37.15	Professional	TC	$10.72	$18.20	$37.15
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $54.95 / $54.95	Professional		$54.95	$54.95	$54.95
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $35.48 / $35.48	Professional	26	$35.48	$35.48	$35.48
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $19.50 / $19.50	Professional	TC	$19.50	$19.50	$19.50