Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $93.33 / $123.03	Facility	26	$57.54	$93.33	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $93.33 / $251.19	Professional		$70.79	$93.33	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $52.48 / $190.55	Professional	26	$38.90	$52.48	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $42.66 / $89.13	Professional	TC	$24.55	$42.66	$89.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $158.49 / $169.82	Professional		$93.33	$158.49	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $125.89 / $288.40	Professional		$79.43	$125.89	$288.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $72.44 / $138.04	Professional	26	$45.71	$72.44	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $57.54 / $144.54	Professional	TC	$26.30	$57.54	$144.54
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $57.54 / $102.33	Facility	26	$40.74	$57.54	$102.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $89.13 / $186.21	Professional		$63.10	$89.13	$186.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $56.23 / $93.33	Professional	26	$40.74	$56.23	$93.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $31.62 / $97.72	Professional	TC	$21.88	$31.62	$97.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $32.36 / $53.70	Professional		$25.70	$32.36	$53.70
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $79.43 / $85.11	Facility	26	$66.07	$79.43	$85.11
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $77.62 / $95.50	Professional	26	$52.48	$77.62	$95.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $42.66 / $83.18	Professional	TC	$28.84	$42.66	$83.18
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $54.95 / $56.23	Facility	26	$54.95	$54.95	$56.23
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $169.82 / $239.88	Professional		$114.82	$169.82	$239.88
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $81.28 / $117.49	Professional	26	$54.95	$81.28	$117.49
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $87.10 / $123.03	Professional	TC	$58.88	$87.10	$123.03
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $72.44 / $72.44	Facility	26	$72.44	$72.44	$72.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $147.91 / $223.87	Professional		$114.82	$147.91	$223.87
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $77.62 / $107.15	Professional	26	$56.23	$77.62	$107.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $74.13 / $114.82	Professional	TC	$43.65	$74.13	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $112.20 / $213.80	Professional		$81.28	$112.20	$213.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $69.18 / $117.49	Professional	26	$45.71	$69.18	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $48.98 / $109.65	Professional	TC	$30.90	$48.98	$109.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $95.50 / $162.18	Professional		$85.11	$95.50	$162.18
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $44.67 / $79.43	Professional	26	$41.69	$44.67	$79.43
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $51.29 / $83.18	Professional	TC	$44.67	$51.29	$83.18