Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.85 / $23.44 / $50.12	Facility	26	$15.85	$23.44	$50.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $85.11 / $288.40	Professional		$53.70	$85.11	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $21.88 / $70.79	Professional	26	$12.02	$21.88	$70.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $52.48 / $138.04	Professional	TC	$37.15	$52.48	$138.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $123.03 / $165.96	Professional		$42.66	$123.03	$165.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $22.39 / $28.84	Professional	26	$10.96	$22.39	$28.84
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $70.79 / $97.72	Professional	TC	$52.48	$70.79	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $97.72 / $190.55	Professional		$53.70	$97.72	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $25.12 / $42.66	Professional	26	$14.13	$25.12	$42.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $74.13 / $147.91	Professional	TC	$38.90	$74.13	$147.91
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $19.50 / $30.20 / $275.42	Facility	26	$19.50	$30.20	$275.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $109.65 / $162.18	Professional		$58.88	$109.65	$162.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $28.18 / $39.81	Professional	26	$16.98	$28.18	$39.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $75.86 / $128.82	Professional	TC	$42.66	$75.86	$128.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $37.15	Professional		$32.36	$32.36	$37.15
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $23.44 / $28.18 / $34.67	Facility	26	$23.44	$28.18	$34.67
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $28.84 / $34.67	Professional	26	$20.89	$28.84	$34.67
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $70.79 / $89.13	Professional	TC	$50.12	$70.79	$89.13
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $19.05 / $19.50	Facility	26	$19.05	$19.05	$19.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $138.04 / $181.97	Professional		$85.11	$138.04	$181.97
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $32.36 / $42.66	Professional	26	$19.50	$32.36	$42.66
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $107.15 / $138.04	Professional	TC	$66.07	$107.15	$138.04
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 $85.11 / $123.03 / $173.78	Professional		$85.11	$123.03	$173.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $30.20 / $40.74	Professional	26	$19.95	$30.20	$40.74
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $95.50 / $134.90	Professional	TC	$66.07	$95.50	$134.90
United Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $69.18 / $154.88	Professional		$56.23	$69.18	$154.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $18.20 / $39.81	Professional	26	$14.45	$18.20	$39.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $50.12 / $117.49	Professional	TC	$38.02	$50.12	$117.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $75.86 / $123.03	Professional		$66.07	$75.86	$123.03
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $16.60 / $27.54	Professional	26	$14.45	$16.60	$27.54
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $58.88 / $97.72	Professional	TC	$51.29	$58.88	$97.72