Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $45.71 / $57.54	Facility	26	$29.51	$45.71	$57.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $61.66 / $128.82	Professional		$38.02	$61.66	$128.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $23.99 / $64.57	Professional	26	$19.05	$23.99	$64.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $36.31 / $70.79	Professional	TC	$18.20	$36.31	$70.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $52.48 / $104.71	Professional		$52.48	$52.48	$104.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $13.49 / $13.49	Professional	26	$13.49	$13.49	$13.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $79.43 / $194.98	Professional		$45.71	$79.43	$194.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $35.48 / $66.07	Professional	26	$22.39	$35.48	$66.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $47.86 / $120.23	Professional	TC	$20.42	$47.86	$120.23
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $28.18 / $51.29	Facility	26	$19.05	$28.18	$51.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $51.29 / $125.89	Professional		$34.67	$51.29	$125.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $26.92 / $46.77	Professional	26	$19.05	$26.92	$46.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $22.91 / $81.28	Professional	TC	$15.49	$22.91	$81.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $13.80 / $32.36 / $36.31	Professional		$13.80	$32.36	$36.31
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $39.81 / $40.74	Facility	26	$33.11	$39.81	$40.74
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $34.67 / $44.67	Professional	26	$25.70	$34.67	$44.67
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $30.20 / $69.18	Professional	TC	$20.89	$30.20	$69.18
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $27.54 / $27.54	Facility	26	$27.54	$27.54	$27.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $114.82 / $162.18	Professional		$77.62	$114.82	$162.18
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $40.74 / $58.88	Professional	26	$27.54	$40.74	$58.88
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $74.13 / $102.33	Professional	TC	$48.98	$74.13	$102.33
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 $67.61 / $97.72 / $147.91	Professional		$67.61	$97.72	$147.91
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $38.02 / $53.70	Professional	26	$28.18	$38.02	$53.70
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $61.66 / $95.50	Professional	TC	$37.15	$61.66	$95.50
United Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $70.79 / $141.25	Professional		$47.86	$70.79	$141.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $33.11 / $57.54	Professional	26	$22.39	$33.11	$57.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $40.74 / $91.20	Professional	TC	$21.38	$40.74	$91.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $64.57 / $109.65	Professional		$57.54	$64.57	$109.65
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $21.88 / $38.90	Professional	26	$20.42	$21.88	$38.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $43.65 / $70.79	Professional	TC	$37.15	$43.65	$70.79