Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $93.33 / $114.82	Facility	26	$63.10	$93.33	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $95.50 / $295.12	Professional		$66.07	$95.50	$295.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $52.48 / $186.21	Professional	26	$38.90	$52.48	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $40.74 / $85.11	Professional	TC	$21.88	$40.74	$85.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $120.23 / $169.82	Professional		$66.07	$120.23	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $117.49 / $269.15	Professional		$74.13	$117.49	$269.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $70.79 / $138.04	Professional	26	$44.67	$70.79	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $52.48 / $131.83	Professional	TC	$23.99	$52.48	$131.83
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $54.95 / $102.33	Facility	26	$38.90	$54.95	$102.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $83.18 / $177.83	Professional		$58.88	$83.18	$177.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $54.95 / $93.33	Professional	26	$38.90	$54.95	$93.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $28.18 / $87.10	Professional	TC	$19.95	$28.18	$87.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $32.36 / $51.29	Professional		$25.70	$32.36	$51.29
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $79.43 / $83.18	Facility	26	$66.07	$79.43	$83.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $69.18 / $85.11	Professional	26	$50.12	$69.18	$85.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $35.48 / $57.54	Professional	TC	$26.30	$35.48	$57.54
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 $107.15 / $162.18 / $229.09	Professional		$107.15	$162.18	$229.09
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 $53.70 / $79.43 / $109.65	Professional	TC	$53.70	$79.43	$109.65
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 $104.71 / $141.25 / $208.93	Professional		$104.71	$141.25	$208.93
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $75.86 / $107.15	Professional	26	$56.23	$75.86	$107.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $67.61 / $104.71	Professional	TC	$39.81	$67.61	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $107.15 / $204.17	Professional		$75.86	$107.15	$204.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $66.07 / $117.49	Professional	26	$44.67	$66.07	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $44.67 / $100.00	Professional	TC	$27.54	$44.67	$100.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $91.20 / $154.88	Professional		$81.28	$91.20	$154.88
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $44.67 / $77.62	Professional	26	$40.74	$44.67	$77.62
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $46.77 / $75.86	Professional	TC	$39.81	$46.77	$75.86