Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $15.14 / $28.84	Facility	26	$9.12	$15.14	$28.84
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.30 / $41.69 / $204.17	Facility	TC	$26.30	$41.69	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $30.20 / $85.11	Professional		$19.05	$30.20	$85.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $10.00 / $35.48	Professional	26	$6.31	$10.00	$35.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $21.88 / $53.70	Professional	TC	$15.85	$21.88	$53.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $41.69 / $77.62	Professional		$39.81	$41.69	$77.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.89 / $6.17 / $15.14	Professional	26	$5.89	$6.17	$15.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $46.77 / $87.10	Professional		$25.12	$46.77	$87.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $12.88 / $23.99	Professional	26	$7.08	$12.88	$23.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $33.11 / $66.07	Professional	TC	$17.78	$33.11	$66.07
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $15.85 / $223.87	Facility	26	$9.33	$15.85	$223.87
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $23.44 / $38.02 / $223.87	Facility	TC	$23.44	$38.02	$223.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $51.29 / $75.86	Professional		$27.54	$51.29	$75.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $14.79 / $20.42	Professional	26	$7.76	$14.79	$20.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $36.31 / $56.23	Professional	TC	$19.50	$36.31	$56.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $32.36 / $33.11	Professional		$14.45	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $15.85 / $16.22	Facility	26	$13.18	$15.85	$16.22
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $31.62 / $38.90 / $42.66	Facility	TC	$31.62	$38.90	$42.66
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $13.18 / $16.98	Professional	26	$9.55	$13.18	$16.98
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $35.48 / $42.66	Professional	TC	$25.70	$35.48	$42.66
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 Facility Modifier TC Low / Median / High Price $28.84 / $28.84 / $29.51	Facility	TC	$28.84	$28.84	$29.51
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $64.57 / $87.10	Professional		$39.81	$64.57	$87.10
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $17.78 / $23.99	Professional	26	$10.96	$17.78	$23.99
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $47.86 / $64.57	Professional	TC	$29.51	$47.86	$64.57
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 $41.69 / $58.88 / $81.28	Professional		$41.69	$58.88	$81.28
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 $28.84 / $42.66 / $60.26	Professional	TC	$28.84	$42.66	$60.26
United Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $32.36 / $74.13	Professional		$25.70	$32.36	$74.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $9.12 / $20.89	Professional	26	$7.24	$9.12	$20.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $22.39 / $53.70	Professional	TC	$18.20	$22.39	$53.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $35.48 / $57.54	Professional		$30.20	$35.48	$57.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $9.33 / $15.49	Professional	26	$8.13	$9.33	$15.49
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $25.70 / $42.66	Professional	TC	$22.39	$25.70	$42.66