Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $32.36 / $50.12	Facility	26	$23.99	$32.36	$50.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $89.13 / $416.87	Professional		$54.95	$89.13	$416.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $22.91 / $144.54	Professional	26	$15.85	$22.91	$144.54
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $229.09 / $229.09 / $245.47	Professional	50	$229.09	$229.09	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $45.71 / $91.20	Professional	TC	$37.15	$45.71	$91.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $112.20 / $144.54	Professional		$60.26	$112.20	$144.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $30.20 / $35.48	Professional	26	$21.88	$30.20	$35.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $102.33 / $190.55	Professional		$64.57	$102.33	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $30.20 / $53.70	Professional	26	$19.50	$30.20	$53.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $72.44 / $134.90	Professional	TC	$43.65	$72.44	$134.90
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $28.18 / $45.71	Facility	26	$16.60	$28.18	$45.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $81.28 / $144.54	Professional		$51.29	$81.28	$144.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $26.30 / $43.65	Professional	26	$15.85	$26.30	$43.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $57.54 / $112.20	Professional	TC	$36.31	$57.54	$112.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.13 / $32.36 / $39.81	Professional		$14.13	$32.36	$39.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $35.48 / $36.31	Facility	26	$29.51	$35.48	$36.31
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $26.92 / $39.81	Professional	26	$21.88	$26.92	$39.81
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $69.18 / $89.13	Professional	TC	$50.12	$69.18	$89.13
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $24.55 / $24.55 / $24.55	Facility	26	$24.55	$24.55	$24.55
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $125.89 / $173.78	Professional		$85.11	$125.89	$173.78
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $37.15 / $52.48	Professional	26	$24.55	$37.15	$52.48
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $89.13 / $120.23	Professional	TC	$60.26	$89.13	$120.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $117.49 / $154.88	Professional		$77.62	$117.49	$154.88
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $34.67 / $45.71	Professional	26	$21.88	$34.67	$45.71
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $83.18 / $109.65	Professional	TC	$56.23	$83.18	$109.65
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $95.50 / $173.78	Professional		$64.57	$95.50	$173.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $28.84 / $51.29	Professional	26	$19.05	$28.84	$51.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $64.57 / $123.03	Professional	TC	$45.71	$64.57	$123.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $77.62 / $128.82	Professional		$67.61	$77.62	$128.82
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $20.42 / $35.48	Professional	26	$18.62	$20.42	$35.48
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $56.23 / $91.20	Professional	TC	$48.98	$56.23	$91.20