Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $14.13 / $30.20	Facility	26	$9.12	$14.13	$30.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $36.31 / $102.33	Professional		$23.99	$36.31	$102.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $8.91 / $25.12	Professional	26	$6.03	$8.91	$25.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $24.55 / $56.23	Professional	TC	$16.22	$24.55	$56.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $66.07 / $66.07	Professional		$66.07	$66.07	$66.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $14.13 / $15.14	Professional	26	$14.13	$14.13	$15.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $48.98 / $100.00	Professional		$27.54	$48.98	$100.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $13.18 / $23.99	Professional	26	$7.41	$13.18	$23.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $37.15 / $77.62	Professional	TC	$19.05	$37.15	$77.62
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $15.85 / $165.96	Facility	26	$9.33	$15.85	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $53.70 / $85.11	Professional		$28.18	$53.70	$85.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $14.79 / $20.42	Professional	26	$8.13	$14.79	$20.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $38.90 / $67.61	Professional	TC	$20.42	$38.90	$67.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $32.36 / $33.11	Professional		$16.98	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $16.22 / $16.60	Facility	26	$13.18	$16.22	$16.60
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.79 / $17.78	Professional	26	$10.00	$14.79	$17.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $36.31 / $44.67	Professional	TC	$25.70	$36.31	$44.67
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $10.96 / $10.96	Facility	26	$10.96	$10.96	$10.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $74.13 / $97.72	Professional		$45.71	$74.13	$97.72
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $17.78 / $25.12	Professional	26	$10.96	$17.78	$25.12
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $56.23 / $74.13	Professional	TC	$34.67	$56.23	$74.13
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 $45.71 / $66.07 / $93.33	Professional		$45.71	$66.07	$93.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $16.98 / $22.39	Professional	26	$11.22	$16.98	$22.39
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $50.12 / $70.79	Professional	TC	$33.88	$50.12	$70.79
United Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $35.48 / $83.18	Professional		$26.30	$35.48	$83.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $9.33 / $21.88	Professional	26	$7.24	$9.33	$21.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $25.70 / $61.66	Professional	TC	$18.62	$25.70	$61.66
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $40.74 / $66.07	Professional		$35.48	$40.74	$66.07
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $9.77 / $16.22	Professional	26	$8.51	$9.77	$16.22
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $30.90 / $50.12	Professional	TC	$26.92	$30.90	$50.12