Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $24.55 / $50.12	Facility	26	$14.79	$24.55	$50.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $67.61 / $181.97	Professional		$45.71	$67.61	$181.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $14.79 / $41.69	Professional	26	$10.96	$14.79	$41.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $46.77 / $125.89	Professional	TC	$31.62	$46.77	$125.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $42.66 / $75.86	Professional		$42.66	$42.66	$75.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $21.38 / $22.39	Professional	26	$21.38	$21.38	$22.39
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $93.33 / $93.33	Professional	TC	$93.33	$93.33	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $89.13 / $181.97	Professional		$50.12	$89.13	$181.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $21.38 / $38.90	Professional	26	$12.02	$21.38	$38.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $67.61 / $144.54	Professional	TC	$35.48	$67.61	$144.54
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $16.22 / $25.70 / $288.40	Facility	26	$16.22	$25.70	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $97.72 / $154.88	Professional		$51.29	$97.72	$154.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $23.99 / $33.88	Professional	26	$13.49	$23.99	$33.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $70.79 / $123.03	Professional	TC	$37.15	$70.79	$123.03
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 $21.38 / $26.30 / $27.54	Facility	26	$21.38	$26.30	$27.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $21.38 / $27.54	Professional	26	$15.85	$21.38	$27.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $77.62 / $93.33	Professional	TC	$48.98	$77.62	$93.33
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $17.78 / $17.78 / $17.78	Facility	26	$17.78	$17.78	$17.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $131.83 / $177.83	Professional		$83.18	$131.83	$177.83
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $28.84 / $38.90	Professional	26	$17.78	$28.84	$38.90
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $102.33 / $138.04	Professional	TC	$64.57	$102.33	$138.04
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 $81.28 / $117.49 / $165.96	Professional		$81.28	$117.49	$165.96
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $27.54 / $36.31	Professional	26	$18.62	$27.54	$36.31
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $91.20 / $128.82	Professional	TC	$63.10	$91.20	$128.82
United Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $61.66 / $147.91	Professional		$48.98	$61.66	$147.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $15.49 / $33.88	Professional	26	$12.59	$15.49	$33.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $46.77 / $112.20	Professional	TC	$35.48	$46.77	$112.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $75.86 / $123.03	Professional		$66.07	$75.86	$123.03
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $15.49 / $25.70	Professional	26	$13.49	$15.49	$25.70
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $60.26 / $97.72	Professional	TC	$52.48	$60.26	$97.72