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 / $33.11	Facility	26	$10.23	$16.98	$33.11
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.18 / $56.23 / $281.84	Facility	TC	$28.18	$56.23	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $38.02 / $128.82	Professional		$20.42	$38.02	$128.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.30 / $35.48	Professional	26	$7.94	$12.30	$35.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $23.44 / $57.54	Professional	TC	$15.85	$23.44	$57.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $24.55 / $53.70	Professional		$22.91	$24.55	$53.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $15.85 / $23.99	Professional	26	$6.61	$15.85	$23.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $50.12 / $100.00	Professional		$27.54	$50.12	$100.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $14.79 / $26.92	Professional	26	$8.13	$14.79	$26.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $35.48 / $74.13	Professional	TC	$19.05	$35.48	$74.13
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $17.78 / $223.87	Facility	26	$10.47	$17.78	$223.87
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $24.55 / $41.69 / $223.87	Facility	TC	$24.55	$41.69	$223.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $56.23 / $85.11	Professional		$29.51	$56.23	$85.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $16.60 / $22.91	Professional	26	$8.91	$16.60	$22.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $38.02 / $63.10	Professional	TC	$20.42	$38.02	$63.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $17.78 / $18.20	Facility	26	$14.79	$17.78	$18.20
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $32.36 / $43.65 / $47.86	Facility	TC	$32.36	$43.65	$47.86
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $15.14 / $19.50	Professional	26	$11.75	$15.14	$19.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $39.81 / $47.86	Professional	TC	$27.54	$39.81	$47.86
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 Facility Modifier TC Low / Median / High Price $31.62 / $31.62 / $33.11	Facility	TC	$31.62	$31.62	$33.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $72.44 / $97.72	Professional		$45.71	$72.44	$97.72
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $19.95 / $26.92	Professional	26	$12.30	$19.95	$26.92
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $52.48 / $70.79	Professional	TC	$33.11	$52.48	$70.79
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 Facility Modifier TC Low / Median / High Price $158.49 / $158.49 / $158.49	Facility	TC	$158.49	$158.49	$158.49
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $66.07 / $93.33	Professional		$44.67	$66.07	$93.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $19.05 / $25.12	Professional	26	$12.88	$19.05	$25.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $47.86 / $67.61	Professional	TC	$32.36	$47.86	$67.61
United Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $35.48 / $83.18	Professional		$28.18	$35.48	$83.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $10.23 / $23.44	Professional	26	$8.32	$10.23	$23.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $24.55 / $58.88	Professional	TC	$19.05	$24.55	$58.88
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 $9.12 / $10.47 / $17.38	Professional	26	$9.12	$10.47	$17.38
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $29.51 / $48.98	Professional	TC	$25.70	$29.51	$48.98