Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $20.42 / $38.90	Facility	26	$12.30	$20.42	$38.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $52.48 / $204.17	Professional		$33.11	$52.48	$204.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $14.13 / $40.74	Professional	26	$8.91	$14.13	$40.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $36.31 / $87.10	Professional	TC	$23.99	$36.31	$87.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $75.86 / $107.15	Professional		$28.18	$75.86	$107.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $17.38 / $19.50	Professional	26	$7.94	$17.38	$19.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $58.88 / $58.88	Professional	TC	$58.88	$58.88	$58.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $69.18 / $123.03	Professional		$36.31	$69.18	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $17.38 / $31.62	Professional	26	$9.77	$17.38	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $51.29 / $93.33	Professional	TC	$26.30	$51.29	$93.33
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $21.38 / $165.96	Facility	26	$12.02	$21.38	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $75.86 / $107.15	Professional		$43.65	$75.86	$107.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $19.95 / $27.54	Professional	26	$10.72	$19.95	$27.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $56.23 / $81.28	Professional	TC	$31.62	$56.23	$81.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $32.36 / $33.11	Professional		$19.95	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.78 / $20.89 / $21.88	Facility	26	$17.78	$20.89	$21.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $19.50 / $23.99	Professional	26	$13.18	$19.50	$23.99
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $52.48 / $69.18	Professional	TC	$34.67	$52.48	$69.18
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $14.45 / $14.45	Facility	26	$14.45	$14.45	$14.45
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $89.13 / $117.49	Professional		$56.23	$89.13	$117.49
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $23.44 / $32.36	Professional	26	$14.45	$23.44	$32.36
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $67.61 / $89.13	Professional	TC	$40.74	$67.61	$89.13
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 $56.23 / $85.11 / $114.82	Professional		$56.23	$85.11	$114.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $22.91 / $30.20	Professional	26	$15.14	$22.91	$30.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $61.66 / $85.11	Professional	TC	$41.69	$61.66	$85.11
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $47.86 / $102.33	Professional		$38.02	$47.86	$102.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $12.30 / $27.54	Professional	26	$9.77	$12.30	$27.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $33.88 / $75.86	Professional	TC	$28.18	$33.88	$75.86
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $50.12 / $83.18	Professional		$43.65	$50.12	$83.18
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $12.59 / $20.89	Professional	26	$10.96	$12.59	$20.89
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $38.02 / $63.10	Professional	TC	$33.11	$38.02	$63.10