Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $17.78 / $31.62	Facility	26	$14.13	$17.78	$31.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $56.23 / $169.82	Professional		$37.15	$56.23	$169.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $16.60 / $47.86	Professional	26	$10.00	$16.60	$47.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $36.31 / $97.72	Professional	TC	$25.12	$36.31	$97.72
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $91.20 / $125.89	Professional		$33.11	$91.20	$125.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $9.55 / $23.44	Professional	26	$9.55	$9.55	$23.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $63.10 / $63.10	Professional	TC	$63.10	$63.10	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $70.79 / $141.25	Professional		$39.81	$70.79	$141.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $19.95 / $36.31	Professional	26	$10.96	$19.95	$36.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $51.29 / $107.15	Professional	TC	$27.54	$51.29	$107.15
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $24.55 / $165.96	Facility	26	$14.13	$24.55	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $79.43 / $123.03	Professional		$40.74	$79.43	$123.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $21.88 / $31.62	Professional	26	$12.30	$21.88	$31.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $56.23 / $93.33	Professional	TC	$28.84	$56.23	$93.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $32.36 / $33.11	Professional		$22.91	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.42 / $24.55 / $25.70	Facility	26	$20.42	$24.55	$25.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $22.39 / $26.92	Professional	26	$14.79	$22.39	$26.92
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $48.98 / $70.79	Professional	TC	$33.88	$48.98	$70.79
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $16.60 / $16.98	Facility	26	$16.60	$16.60	$16.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $104.71 / $134.90	Professional		$64.57	$104.71	$134.90
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $27.54 / $37.15	Professional	26	$16.98	$27.54	$37.15
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $77.62 / $102.33	Professional	TC	$47.86	$77.62	$102.33
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $93.33 / $131.83	Professional		$66.07	$93.33	$131.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $26.30 / $34.67	Professional	26	$17.38	$26.30	$34.67
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $69.18 / $97.72	Professional	TC	$48.98	$69.18	$97.72
United Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $51.29 / $117.49	Professional		$38.90	$51.29	$117.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $13.80 / $33.11	Professional	26	$11.22	$13.80	$33.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $35.48 / $85.11	Professional	TC	$28.18	$35.48	$85.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $56.23 / $93.33	Professional		$48.98	$56.23	$93.33
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $14.45 / $23.99	Professional	26	$12.59	$14.45	$23.99
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $41.69 / $69.18	Professional	TC	$36.31	$41.69	$69.18