Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $15.85 / $28.84	Facility	26	$10.00	$15.85	$28.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $36.31 / $158.49	Professional		$23.44	$36.31	$158.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.72 / $43.65	Professional	26	$7.08	$10.72	$43.65
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $16.22 / $66.07 / $169.82	Professional	50	$16.22	$66.07	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $23.99 / $58.88	Professional	TC	$15.85	$23.99	$58.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $67.61 / $85.11	Professional		$56.23	$67.61	$85.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $16.98 / $20.89	Professional	26	$6.61	$16.98	$20.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $47.86 / $97.72	Professional		$26.30	$47.86	$97.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $13.49 / $24.55	Professional	26	$7.41	$13.49	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $35.48 / $74.13	Professional	TC	$18.20	$35.48	$74.13
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $16.22 / $165.96	Facility	26	$8.91	$16.22	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $53.70 / $85.11	Professional		$27.54	$53.70	$85.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $15.14 / $21.38	Professional	26	$7.76	$15.14	$21.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $38.02 / $64.57	Professional	TC	$20.42	$38.02	$64.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $16.22 / $32.36 / $33.11	Professional		$16.22	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $16.22 / $16.60	Facility	26	$13.80	$16.22	$16.60
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $14.45 / $17.78	Professional	26	$9.55	$14.45	$17.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $34.67 / $44.67	Professional	TC	$23.99	$34.67	$44.67
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $11.48 / $11.75	Facility	26	$11.48	$11.48	$11.75
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $72.44 / $95.50	Professional		$44.67	$72.44	$95.50
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $18.62 / $26.30	Professional	26	$11.48	$18.62	$26.30
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $53.70 / $70.79	Professional	TC	$33.11	$53.70	$70.79
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $158.49 / $158.49 / $158.49	Facility	26	$158.49	$158.49	$158.49
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $64.57 / $91.20	Professional		$44.67	$64.57	$91.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $17.78 / $23.99	Professional	26	$12.02	$17.78	$23.99
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $47.86 / $69.18	Professional	TC	$33.11	$47.86	$69.18
United Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $34.67 / $81.28	Professional		$25.70	$34.67	$81.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $9.55 / $21.88	Professional	26	$7.76	$9.55	$21.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $24.55 / $58.88	Professional	TC	$18.20	$24.55	$58.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $38.90 / $64.57	Professional		$33.88	$38.90	$64.57
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $10.23 / $16.60	Professional	26	$8.71	$10.23	$16.60
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $28.84 / $47.86	Professional	TC	$25.12	$28.84	$47.86