Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $19.50 / $42.66	Facility	26	$14.79	$19.50	$42.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $74.13 / $218.78	Professional		$46.77	$74.13	$218.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $20.89 / $58.88	Professional	26	$12.02	$20.89	$58.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $47.86 / $131.83	Professional	TC	$32.36	$47.86	$131.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $100.00 / $131.83	Professional		$47.86	$100.00	$131.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $21.88 / $23.99	Professional	26	$9.77	$21.88	$23.99
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $69.18 / $89.13	Professional	TC	$43.65	$69.18	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $83.18 / $162.18	Professional		$44.67	$83.18	$162.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $21.88 / $38.02	Professional	26	$12.88	$21.88	$38.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $60.26 / $125.89	Professional	TC	$31.62	$60.26	$125.89
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $26.30 / $275.42	Facility	26	$16.60	$26.30	$275.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $87.10 / $138.04	Professional		$46.77	$87.10	$138.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $25.70 / $34.67	Professional	26	$14.45	$25.70	$34.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $61.66 / $109.65	Professional	TC	$33.11	$61.66	$109.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $32.36 / $33.11	Professional		$27.54	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $25.70 / $30.20	Facility	26	$20.89	$25.70	$30.20
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $26.30 / $31.62	Professional	26	$19.05	$26.30	$31.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $56.23 / $74.13	Professional	TC	$38.90	$56.23	$74.13
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $17.38 / $17.78	Facility	26	$17.38	$17.38	$17.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $117.49 / $158.49	Professional		$74.13	$117.49	$158.49
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $28.84 / $38.90	Professional	26	$17.38	$28.84	$38.90
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $89.13 / $120.23	Professional	TC	$56.23	$89.13	$120.23
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 $74.13 / $107.15 / $147.91	Professional		$74.13	$107.15	$147.91
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $27.54 / $36.31	Professional	26	$18.20	$27.54	$36.31
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $79.43 / $114.82	Professional	TC	$54.95	$79.43	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $57.54 / $131.83	Professional		$44.67	$57.54	$131.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $15.85 / $36.31	Professional	26	$12.59	$15.85	$36.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $40.74 / $97.72	Professional	TC	$29.51	$40.74	$97.72
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $66.07 / $109.65	Professional		$57.54	$66.07	$109.65
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $15.14 / $25.12	Professional	26	$13.18	$15.14	$25.12
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $51.29 / $83.18	Professional	TC	$44.67	$51.29	$83.18