Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.44 / $27.54 / $47.86	Facility	26	$23.44	$27.54	$47.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $56.23 / $234.42	Professional		$40.74	$56.23	$234.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $30.20 / $83.18	Professional	26	$23.44	$30.20	$83.18
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $33.11 / $309.03 / $323.59	Professional	52	$33.11	$309.03	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $23.99 / $100.00	Professional	TC	$15.85	$23.99	$100.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $83.18 / $95.50	Professional		$30.20	$83.18	$95.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $45.71 / $52.48	Professional	26	$30.90	$45.71	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $38.90 / $38.90	Professional		$38.90	$38.90	$38.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $25.12 / $25.12	Professional	26	$25.12	$25.12	$25.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $14.13 / $14.13	Professional	TC	$14.13	$14.13	$14.13
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $56.23 / $87.10	Facility	26	$33.11	$56.23	$87.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $95.50 / $134.90	Professional		$53.70	$95.50	$134.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $52.48 / $72.44	Professional	26	$28.18	$52.48	$72.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $43.65 / $61.66	Professional	TC	$25.70	$43.65	$61.66
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $32.36 / $33.11	Professional		$27.54	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $56.23 / $57.54	Facility	26	$45.71	$56.23	$57.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $45.71 / $58.88	Professional	26	$34.67	$45.71	$58.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $30.90 / $48.98	Professional	TC	$25.70	$30.90	$48.98
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $38.02 / $38.90	Facility	26	$38.02	$38.02	$38.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $104.71 / $141.25	Professional		$64.57	$104.71	$141.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $58.88 / $83.18	Professional	26	$38.02	$58.88	$83.18
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $43.65 / $63.10	Professional	TC	$26.30	$43.65	$63.10
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $48.98 / $48.98	Facility	26	$48.98	$48.98	$48.98
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $100.00 / $128.82	Professional		$72.44	$100.00	$128.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $54.95 / $72.44	Professional	26	$39.81	$54.95	$72.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $43.65 / $53.70	Professional	TC	$32.36	$43.65	$53.70
United Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $66.07 / $138.04	Professional		$50.12	$66.07	$138.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $35.48 / $74.13	Professional	26	$26.30	$35.48	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $29.51 / $61.66	Professional	TC	$21.38	$29.51	$61.66
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $47.86 / $79.43	Professional		$41.69	$47.86	$79.43
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $32.36 / $53.70	Professional	26	$28.18	$32.36	$53.70
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $13.49 / $15.49 / $25.12	Professional	TC	$13.49	$15.49	$25.12