Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $16.22 / $33.11	Facility	26	$14.13	$16.22	$33.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $72.44 / $223.87	Professional		$46.77	$72.44	$223.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $19.95 / $60.26	Professional	26	$11.75	$19.95	$60.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $45.71 / $114.82	Professional	TC	$32.36	$45.71	$114.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $85.11 / $120.23	Professional		$37.15	$85.11	$120.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $14.13 / $22.91	Professional	26	$8.13	$14.13	$22.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $72.44 / $85.11	Professional	TC	$35.48	$72.44	$85.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $81.28 / $154.88	Professional		$44.67	$81.28	$154.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $21.88 / $37.15	Professional	26	$12.30	$21.88	$37.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $60.26 / $123.03	Professional	TC	$32.36	$60.26	$123.03
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 $48.98 / $91.20 / $134.90	Professional		$48.98	$91.20	$134.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $24.55 / $34.67	Professional	26	$14.45	$24.55	$34.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $63.10 / $104.71	Professional	TC	$34.67	$63.10	$104.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $32.36 / $33.11	Professional		$26.30	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.42 / $24.55 / $30.20	Facility	26	$20.42	$24.55	$30.20
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $24.55 / $30.90	Professional	26	$18.62	$24.55	$30.90
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $60.26 / $79.43	Professional	TC	$41.69	$60.26	$79.43
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 $70.79 / $114.82 / $151.36	Professional		$70.79	$114.82	$151.36
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $27.54 / $38.02	Professional	26	$16.98	$27.54	$38.02
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $87.10 / $114.82	Professional	TC	$54.95	$87.10	$114.82
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 $70.79 / $104.71 / $144.54	Professional		$70.79	$104.71	$144.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $26.30 / $35.48	Professional	26	$17.38	$26.30	$35.48
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $77.62 / $112.20	Professional	TC	$53.70	$77.62	$112.20
United Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $56.23 / $128.82	Professional		$46.77	$56.23	$128.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $15.85 / $34.67	Professional	26	$12.30	$15.85	$34.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $39.81 / $95.50	Professional	TC	$32.36	$39.81	$95.50
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $64.57 / $104.71	Professional		$56.23	$64.57	$104.71
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 $42.66 / $48.98 / $81.28	Professional	TC	$42.66	$48.98	$81.28