Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $21.88 / $43.65	Facility	26	$16.98	$21.88	$43.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $61.66 / $229.09	Professional		$42.66	$61.66	$229.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $21.38 / $54.95	Professional	26	$12.88	$21.38	$54.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $41.69 / $97.72	Professional	TC	$28.84	$41.69	$97.72
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $33.88 / $87.10	Professional		$33.88	$33.88	$87.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $11.48 / $27.54	Professional	26	$11.22	$11.48	$27.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $81.28 / $158.49	Professional		$45.71	$81.28	$158.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $25.12 / $45.71	Professional	26	$13.80	$25.12	$45.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $57.54 / $114.82	Professional	TC	$30.90	$57.54	$114.82
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $17.78 / $30.20 / $275.42	Facility	26	$17.78	$30.20	$275.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $91.20 / $138.04	Professional		$50.12	$91.20	$138.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $27.54 / $38.90	Professional	26	$15.49	$27.54	$38.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $61.66 / $100.00	Professional	TC	$33.11	$61.66	$100.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $32.36 / $33.11	Professional		$25.12	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $30.20 / $31.62	Facility	26	$25.12	$30.20	$31.62
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $53.70 / $53.70	Professional		$53.70	$53.70	$53.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $27.54 / $33.88	Professional	26	$19.05	$27.54	$33.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $61.66 / $77.62	Professional	TC	$41.69	$61.66	$77.62
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $20.42 / $20.42 / $20.89	Facility	26	$20.42	$20.42	$20.89
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $114.82 / $151.36	Professional		$72.44	$114.82	$151.36
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $33.88 / $44.67	Professional	26	$20.89	$33.88	$44.67
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $81.28 / $112.20	Professional	TC	$51.29	$81.28	$112.20
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 $72.44 / $104.71 / $147.91	Professional		$72.44	$104.71	$147.91
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $31.62 / $43.65	Professional	26	$21.38	$31.62	$43.65
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $74.13 / $104.71	Professional	TC	$51.29	$74.13	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $57.54 / $131.83	Professional		$45.71	$57.54	$131.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $16.98 / $39.81	Professional	26	$14.13	$16.98	$39.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $38.90 / $93.33	Professional	TC	$30.90	$38.90	$93.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $61.66 / $102.33	Professional		$53.70	$61.66	$102.33
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $17.38 / $28.84	Professional	26	$15.14	$17.38	$28.84
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $43.65 / $72.44	Professional	TC	$38.02	$43.65	$72.44