Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $22.39 / $47.86	Facility	26	$15.49	$22.39	$47.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $47.86 / $134.90	Professional		$33.88	$47.86	$134.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $16.98 / $45.71	Professional	26	$10.96	$16.98	$45.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $32.36 / $75.86	Professional	TC	$22.39	$32.36	$75.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $23.99 / $23.99	Professional	26	$10.23	$23.99	$23.99
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $44.67 / $72.44	Professional	TC	$44.67	$44.67	$72.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $67.61 / $131.83	Professional		$37.15	$67.61	$131.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $21.38 / $40.74	Professional	26	$12.02	$21.38	$40.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $44.67 / $93.33	Professional	TC	$24.55	$44.67	$93.33
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $26.30 / $165.96	Facility	26	$15.49	$26.30	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $75.86 / $112.20	Professional		$39.81	$75.86	$112.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $23.99 / $35.48	Professional	26	$13.49	$23.99	$35.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $50.12 / $81.28	Professional	TC	$26.30	$50.12	$81.28
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 $22.39 / $26.30 / $28.18	Facility	26	$22.39	$26.30	$28.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $23.44 / $27.54	Professional	26	$16.60	$23.44	$27.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $44.67 / $58.88	Professional	TC	$31.62	$44.67	$58.88
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $18.62 / $18.62	Facility	26	$18.62	$18.62	$18.62
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $97.72 / $125.89	Professional		$60.26	$97.72	$125.89
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $30.20 / $40.74	Professional	26	$18.62	$30.20	$40.74
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $67.61 / $89.13	Professional	TC	$41.69	$67.61	$89.13
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 $60.26 / $87.10 / $123.03	Professional		$60.26	$87.10	$123.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $28.84 / $38.90	Professional	26	$19.50	$28.84	$38.90
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $60.26 / $85.11	Professional	TC	$41.69	$60.26	$85.11
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $47.86 / $109.65	Professional		$38.02	$47.86	$109.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $15.14 / $36.31	Professional	26	$12.02	$15.14	$36.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $31.62 / $74.13	Professional	TC	$23.44	$31.62	$74.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $51.29 / $85.11	Professional		$44.67	$51.29	$85.11
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $15.49 / $25.70	Professional	26	$13.49	$15.49	$25.70
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $35.48 / $58.88	Professional	TC	$30.90	$35.48	$58.88