Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $56.23 / $154.88	Facility	26	$34.67	$56.23	$154.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $66.07 / $186.21	Professional		$43.65	$66.07	$186.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $30.20 / $107.15	Professional	26	$22.91	$30.20	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $34.67 / $77.62	Professional	TC	$16.98	$34.67	$77.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $66.07	Professional		$57.54	$57.54	$66.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $87.10 / $204.17	Professional		$51.29	$87.10	$204.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $43.65 / $83.18	Professional	26	$27.54	$43.65	$83.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $46.77 / $117.49	Professional	TC	$19.95	$46.77	$117.49
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $34.67 / $64.57	Facility	26	$23.99	$34.67	$64.57
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $56.23 / $131.83	Professional		$38.90	$56.23	$131.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $33.11 / $57.54	Professional	26	$23.44	$33.11	$57.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $22.39 / $79.43	Professional	TC	$15.14	$22.39	$79.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $32.36 / $38.02	Professional		$16.98	$32.36	$38.02
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $48.98 / $51.29	Facility	26	$40.74	$48.98	$51.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $42.66 / $53.70	Professional	26	$32.36	$42.66	$53.70
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $28.84 / $61.66	Professional	TC	$20.42	$28.84	$61.66
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $33.88 / $33.88	Facility	26	$33.88	$33.88	$33.88
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $120.23 / $169.82	Professional		$81.28	$120.23	$169.82
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $50.12 / $72.44	Professional	26	$33.88	$50.12	$72.44
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $70.79 / $100.00	Professional	TC	$47.86	$70.79	$100.00
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 $74.13 / $104.71 / $158.49	Professional		$74.13	$104.71	$158.49
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $46.77 / $66.07	Professional	26	$34.67	$46.77	$66.07
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $60.26 / $93.33	Professional	TC	$36.31	$60.26	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $77.62 / $154.88	Professional		$52.48	$77.62	$154.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $40.74 / $70.79	Professional	26	$26.92	$40.74	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $38.90 / $89.13	Professional	TC	$21.38	$38.90	$89.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $69.18 / $117.49	Professional		$61.66	$69.18	$117.49
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $27.54 / $48.98	Professional	26	$25.70	$27.54	$48.98
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $41.69 / $69.18	Professional	TC	$36.31	$41.69	$69.18