Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $16.98 / $35.48	Facility	26	$14.45	$16.98	$35.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $48.98 / $158.49	Professional		$21.88	$48.98	$158.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $17.78 / $46.77	Professional	26	$10.96	$17.78	$46.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $36.31 / $89.13	Professional	TC	$23.99	$36.31	$89.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $70.79 / $91.20	Professional		$28.84	$70.79	$91.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $20.89 / $23.99	Professional	26	$9.55	$20.89	$23.99
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $47.86 / $67.61	Professional	TC	$26.30	$47.86	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $64.57 / $125.89	Professional		$35.48	$64.57	$125.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $20.42 / $38.02	Professional	26	$11.48	$20.42	$38.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $43.65 / $91.20	Professional	TC	$23.99	$43.65	$91.20
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $25.12 / $165.96	Facility	26	$14.79	$25.12	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $72.44 / $109.65	Professional		$37.15	$72.44	$109.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $22.91 / $32.36	Professional	26	$12.59	$22.91	$32.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $48.98 / $79.43	Professional	TC	$25.70	$48.98	$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 $20.89 / $25.12 / $25.70	Facility	26	$20.89	$25.12	$25.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $22.39 / $28.18	Professional	26	$15.85	$22.39	$28.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $43.65 / $57.54	Professional	TC	$30.90	$43.65	$57.54
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $17.38 / $17.38	Facility	26	$17.38	$17.38	$17.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $93.33 / $123.03	Professional		$57.54	$93.33	$123.03
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $28.18 / $38.02	Professional	26	$17.38	$28.18	$38.02
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 $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $85.11 / $117.49	Professional		$57.54	$85.11	$117.49
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $26.92 / $35.48	Professional	26	$17.78	$26.92	$35.48
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 $35.48 / $45.71 / $107.15	Professional		$35.48	$45.71	$107.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $14.13 / $33.11	Professional	26	$11.48	$14.13	$33.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $30.20 / $72.44	Professional	TC	$22.39	$30.20	$72.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $50.12 / $83.18	Professional		$43.65	$50.12	$83.18
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $14.79 / $24.55	Professional	26	$12.88	$14.79	$24.55
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $34.67 / $57.54	Professional	TC	$30.20	$34.67	$57.54