Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $75.86 / $125.89	Facility	26	$50.12	$75.86	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $83.18 / $208.93	Professional		$64.57	$83.18	$208.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $47.86 / $123.03	Professional	26	$33.11	$47.86	$123.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $38.02 / $75.86	Professional	TC	$20.89	$38.02	$75.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $112.20 / $131.83	Professional		$56.23	$112.20	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $112.20 / $245.47	Professional		$69.18	$112.20	$245.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $66.07 / $120.23	Professional	26	$39.81	$66.07	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $48.98 / $123.03	Professional	TC	$22.91	$48.98	$123.03
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $52.48 / $93.33	Facility	26	$38.90	$52.48	$93.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $77.62 / $158.49	Professional		$56.23	$77.62	$158.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $51.29 / $81.28	Professional	26	$36.31	$51.29	$81.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $26.30 / $81.28	Professional	TC	$18.62	$26.30	$81.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $32.36 / $46.77	Professional		$22.39	$32.36	$46.77
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $70.79 / $87.10	Facility	26	$58.88	$70.79	$87.10
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $72.44 / $89.13	Professional	26	$51.29	$72.44	$89.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $35.48 / $61.66	Professional	TC	$23.99	$35.48	$61.66
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $48.98 / $48.98	Facility	26	$48.98	$48.98	$48.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $144.54 / $204.17	Professional		$97.72	$144.54	$204.17
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $72.44 / $102.33	Professional	26	$48.98	$72.44	$102.33
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $74.13 / $102.33	Professional	TC	$50.12	$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 $102.33 / $128.82 / $190.55	Professional		$102.33	$128.82	$190.55
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $67.61 / $93.33	Professional	26	$50.12	$67.61	$93.33
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 $70.79 / $97.72 / $186.21	Professional		$70.79	$97.72	$186.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $61.66 / $102.33	Professional	26	$42.66	$61.66	$102.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $41.69 / $91.20	Professional	TC	$26.30	$41.69	$91.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $83.18 / $141.25	Professional		$74.13	$83.18	$141.25
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $38.90 / $69.18	Professional	26	$36.31	$38.90	$69.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $43.65 / $70.79	Professional	TC	$37.15	$43.65	$70.79