Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $16.60 / $26.92	Facility	26	$12.02	$16.60	$26.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $46.77 / $147.91	Professional		$31.62	$46.77	$147.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $15.14 / $38.90	Professional	26	$8.71	$15.14	$38.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $30.90 / $91.20	Professional	TC	$21.88	$30.90	$91.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $74.13 / $104.71	Professional		$26.92	$74.13	$104.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $17.38 / $18.62	Professional	26	$7.94	$17.38	$18.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $53.70 / $66.07	Professional	TC	$53.70	$53.70	$66.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $58.88 / $117.49	Professional		$32.36	$58.88	$117.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $15.85 / $31.62	Professional	26	$9.12	$15.85	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $42.66 / $89.13	Professional	TC	$22.91	$42.66	$89.13
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $18.62 / $165.96	Facility	26	$10.47	$18.62	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $63.10 / $100.00	Professional		$33.11	$63.10	$100.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $17.78 / $25.70	Professional	26	$8.71	$17.78	$25.70
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $46.77 / $75.86	Professional	TC	$24.55	$46.77	$75.86
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $32.36 / $33.11	Professional		$19.50	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $20.42 / $21.88	Facility	26	$15.49	$20.42	$21.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $16.22 / $21.88	Professional	26	$11.22	$16.22	$21.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $42.66 / $57.54	Professional	TC	$29.51	$42.66	$57.54
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 $53.70 / $87.10 / $114.82	Professional		$53.70	$87.10	$114.82
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $23.44 / $30.90	Professional	26	$14.45	$23.44	$30.90
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $63.10 / $85.11	Professional	TC	$38.90	$63.10	$85.11
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 $53.70 / $77.62 / $109.65	Professional		$53.70	$77.62	$109.65
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $21.38 / $30.20	Professional	26	$14.79	$21.38	$30.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $56.23 / $81.28	Professional	TC	$38.90	$56.23	$81.28
United Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $42.66 / $97.72	Professional		$30.90	$42.66	$97.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $12.02 / $27.54	Professional	26	$8.91	$12.02	$27.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $28.84 / $69.18	Professional	TC	$22.91	$28.84	$69.18
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $46.77 / $75.86	Professional		$40.74	$46.77	$75.86
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $12.02 / $19.95	Professional	26	$10.47	$12.02	$19.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $33.88 / $56.23	Professional	TC	$29.51	$33.88	$56.23