Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $23.44 / $45.71	Facility	26	$14.13	$23.44	$45.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $50.12 / $165.96	Professional		$33.88	$50.12	$165.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $18.20 / $54.95	Professional	26	$10.96	$18.20	$54.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $33.11 / $85.11	Professional	TC	$22.91	$33.11	$85.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $97.72	Professional		$85.11	$85.11	$97.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $9.12 / $9.12	Professional	26	$9.12	$9.12	$9.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $72.44 / $72.44	Professional	TC	$72.44	$72.44	$72.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $66.07 / $128.82	Professional		$35.48	$66.07	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $20.42 / $36.31	Professional	26	$10.96	$20.42	$36.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $44.67 / $93.33	Professional	TC	$23.99	$44.67	$93.33
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $24.55 / $223.87	Facility	26	$14.79	$24.55	$223.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $72.44 / $109.65	Professional		$38.02	$72.44	$109.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $22.91 / $31.62	Professional	26	$12.30	$22.91	$31.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $47.86 / $81.28	Professional	TC	$25.12	$47.86	$81.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.42 / $24.55 / $25.70	Facility	26	$20.42	$24.55	$25.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $22.39 / $28.18	Professional	26	$16.22	$22.39	$28.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $50.12 / $61.66	Professional	TC	$33.88	$50.12	$61.66
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $16.60 / $16.98	Facility	26	$16.60	$16.60	$16.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $93.33 / $125.89	Professional		$58.88	$93.33	$125.89
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $27.54 / $37.15	Professional	26	$16.98	$27.54	$37.15
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $66.07 / $91.20	Professional	TC	$41.69	$66.07	$91.20
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $158.49 / $158.49 / $158.49	Facility	26	$158.49	$158.49	$158.49
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $85.11 / $120.23	Professional		$58.88	$85.11	$120.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $26.30 / $34.67	Professional	26	$17.38	$26.30	$34.67
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 $36.31 / $45.71 / $107.15	Professional		$36.31	$45.71	$107.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $14.45 / $33.11	Professional	26	$11.48	$14.45	$33.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $30.90 / $74.13	Professional	TC	$23.99	$30.90	$74.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $52.48 / $87.10	Professional		$45.71	$52.48	$87.10
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 $33.11 / $38.02 / $63.10	Professional	TC	$33.11	$38.02	$63.10