Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $11.48 / $23.44	Facility	26	$9.55	$11.48	$23.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $44.67 / $128.82	Professional		$28.84	$44.67	$128.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $12.30 / $41.69	Professional	26	$7.08	$12.30	$41.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $31.62 / $77.62	Professional	TC	$19.95	$31.62	$77.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $33.11 / $72.44	Professional		$25.70	$33.11	$72.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $14.13 / $15.14	Professional	26	$6.31	$14.13	$15.14
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $53.70 / $67.61	Professional	TC	$41.69	$53.70	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $56.23 / $114.82	Professional		$30.20	$56.23	$114.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $13.18 / $23.99	Professional	26	$7.41	$13.18	$23.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $42.66 / $91.20	Professional	TC	$21.88	$42.66	$91.20
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $15.85 / $165.96	Facility	26	$9.33	$15.85	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $63.10 / $97.72	Professional		$32.36	$63.10	$97.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $15.14 / $20.89	Professional	26	$8.13	$15.14	$20.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $47.86 / $79.43	Professional	TC	$24.55	$47.86	$79.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $32.36 / $33.11	Professional		$19.95	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $16.22 / $16.60	Facility	26	$13.18	$16.22	$16.60
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.79 / $17.78	Professional	26	$10.00	$14.79	$17.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $41.69 / $57.54	Professional	TC	$29.51	$41.69	$57.54
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $10.96 / $11.22	Facility	26	$10.96	$10.96	$11.22
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $83.18 / $109.65	Professional		$51.29	$83.18	$109.65
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $18.20 / $24.55	Professional	26	$10.96	$18.20	$24.55
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $66.07 / $87.10	Professional	TC	$40.74	$66.07	$87.10
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 $52.48 / $75.86 / $107.15	Professional		$52.48	$75.86	$107.15
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $17.78 / $22.91	Professional	26	$11.48	$17.78	$22.91
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $58.88 / $83.18	Professional	TC	$40.74	$58.88	$83.18
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $39.81 / $95.50	Professional		$29.51	$39.81	$95.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $9.33 / $21.88	Professional	26	$7.59	$9.33	$21.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $30.20 / $72.44	Professional	TC	$21.38	$30.20	$72.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $44.67 / $74.13	Professional		$38.90	$44.67	$74.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $9.77 / $16.22	Professional	26	$8.51	$9.77	$16.22
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $34.67 / $57.54	Professional	TC	$30.20	$34.67	$57.54