Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $13.49 / $21.38	Facility	26	$9.55	$13.49	$21.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $47.86 / $131.83	Professional		$30.20	$47.86	$131.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.96 / $35.48	Professional	26	$7.08	$10.96	$35.48
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.90 / $38.90 / $58.88	Professional	50	$38.90	$38.90	$58.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $33.11 / $79.43	Professional	TC	$20.89	$33.11	$79.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $53.70 / $83.18	Professional		$25.70	$53.70	$83.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $13.49 / $15.85	Professional	26	$13.49	$13.49	$15.85
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $50.12 / $50.12	Professional	TC	$50.12	$50.12	$50.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $58.88 / $120.23	Professional		$30.90	$58.88	$120.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $13.80 / $23.99	Professional	26	$7.59	$13.80	$23.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $45.71 / $97.72	Professional	TC	$21.38	$45.71	$97.72
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $16.60 / $165.96	Facility	26	$9.77	$16.60	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $67.61 / $104.71	Professional		$33.11	$67.61	$104.71
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $15.85 / $21.38	Professional	26	$8.51	$15.85	$21.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $51.29 / $85.11	Professional	TC	$25.12	$51.29	$85.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $32.36 / $33.11	Professional		$21.38	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $16.22 / $16.98	Facility	26	$13.18	$16.22	$16.98
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $36.31 / $36.31	Professional		$36.31	$36.31	$36.31
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.14 / $19.05	Professional	26	$10.00	$15.14	$19.05
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $40.74 / $63.10	Professional	TC	$32.36	$40.74	$63.10
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $10.96 / $11.22	Facility	26	$10.96	$10.96	$11.22
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $87.10 / $117.49	Professional		$54.95	$87.10	$117.49
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $18.20 / $25.12	Professional	26	$10.96	$18.20	$25.12
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $70.79 / $93.33	Professional	TC	$43.65	$70.79	$93.33
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 $56.23 / $79.43 / $112.20	Professional		$56.23	$79.43	$112.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $17.78 / $22.91	Professional	26	$11.48	$17.78	$22.91
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $63.10 / $89.13	Professional	TC	$44.67	$63.10	$89.13
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $40.74 / $100.00	Professional		$29.51	$40.74	$100.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $9.77 / $21.88	Professional	26	$7.94	$9.77	$21.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $31.62 / $79.43	Professional	TC	$21.88	$31.62	$79.43
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $50.12 / $83.18	Professional		$43.65	$50.12	$83.18
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $9.77 / $16.22	Professional	26	$8.51	$9.77	$16.22
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $40.74 / $67.61	Professional	TC	$35.48	$40.74	$67.61