Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $16.98 / $36.31	Facility	26	$10.23	$16.98	$36.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $38.90 / $123.03	Professional		$23.99	$38.90	$123.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.96 / $33.88	Professional	26	$7.08	$10.96	$33.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $37.15 / $54.95	Professional	52	$30.20	$37.15	$54.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $25.12 / $69.18	Professional	TC	$15.14	$25.12	$69.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $46.77 / $46.77	Professional		$46.77	$46.77	$46.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $15.85 / $16.22	Professional	26	$12.02	$15.85	$16.22
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $33.88 / $33.88	Professional	TC	$33.88	$33.88	$33.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $51.29 / $91.20	Professional		$28.18	$51.29	$91.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $15.49 / $26.92	Professional	26	$8.91	$15.49	$26.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $35.48 / $63.10	Professional	TC	$19.05	$35.48	$63.10
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $11.22 / $18.20 / $165.96	Facility	26	$11.22	$18.20	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $61.66 / $83.18	Professional		$35.48	$61.66	$83.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $17.78 / $24.55	Professional	26	$10.00	$17.78	$24.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $44.67 / $60.26	Professional	TC	$25.70	$44.67	$60.26
Molina Facility/Professional Professional Modifier Low / Median / High Price $13.49 / $32.36 / $33.11	Professional		$13.49	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $17.78 / $19.95	Facility	26	$14.79	$17.78	$19.95
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $18.20 / $21.88	Professional	26	$12.59	$18.20	$21.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $41.69 / $53.70	Professional	TC	$30.20	$41.69	$53.70
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $64.57 / $85.11	Professional		$39.81	$64.57	$85.11
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $20.42 / $26.92	Professional	26	$12.30	$20.42	$26.92
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $44.67 / $60.26	Professional	TC	$27.54	$44.67	$60.26
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 $40.74 / $60.26 / $81.28	Professional		$40.74	$60.26	$81.28
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $19.50 / $25.70	Professional	26	$12.88	$19.50	$25.70
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $41.69 / $57.54	Professional	TC	$27.54	$41.69	$57.54
United Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $36.31 / $77.62	Professional		$28.84	$36.31	$77.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $10.96 / $25.12	Professional	26	$8.91	$10.96	$25.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $25.70 / $56.23	Professional	TC	$19.95	$25.70	$56.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $36.31 / $60.26	Professional		$31.62	$36.31	$60.26
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $10.96 / $18.20	Professional	26	$9.55	$10.96	$18.20
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $25.12 / $41.69	Professional	TC	$21.88	$25.12	$41.69