Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $15.85 / $30.20	Facility	26	$9.55	$15.85	$30.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $36.31 / $104.71	Professional		$25.12	$36.31	$104.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $8.91 / $28.84	Professional	26	$7.08	$8.91	$28.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $25.70 / $61.66	Professional	TC	$18.20	$25.70	$61.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $45.71 / $60.26	Professional		$22.39	$45.71	$60.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.17 / $13.49 / $15.14	Professional	26	$6.17	$13.49	$15.14
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $43.65 / $43.65	Professional	TC	$43.65	$43.65	$43.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $50.12 / $97.72	Professional		$27.54	$50.12	$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 $19.95 / $36.31 / $74.13	Professional	TC	$19.95	$36.31	$74.13
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $16.60 / $165.96	Facility	26	$9.33	$16.60	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $57.54 / $85.11	Professional		$29.51	$57.54	$85.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $15.14 / $21.38	Professional	26	$8.13	$15.14	$21.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $41.69 / $63.10	Professional	TC	$21.88	$41.69	$63.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $32.36 / $33.11	Professional		$15.85	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $16.60 / $16.60	Facility	26	$13.80	$16.60	$16.60
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.14 / $18.62	Professional	26	$10.00	$15.14	$18.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $37.15 / $50.12	Professional	TC	$25.12	$37.15	$50.12
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $11.22 / $11.22 / $11.48	Facility	26	$11.22	$11.22	$11.48
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $70.79 / $93.33	Professional		$44.67	$70.79	$93.33
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $18.62 / $25.12	Professional	26	$11.48	$18.62	$25.12
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 $11.75 / $17.78 / $23.44	Professional	26	$11.75	$17.78	$23.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $47.86 / $67.61	Professional	TC	$33.11	$47.86	$67.61
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $34.67 / $81.28	Professional		$29.51	$34.67	$81.28
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 $20.42 / $24.55 / $58.88	Professional	TC	$20.42	$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 $8.51 / $9.77 / $16.22	Professional	26	$8.51	$9.77	$16.22
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $28.84 / $47.86	Professional	TC	$25.12	$28.84	$47.86