Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $22.91 / $32.36	Facility	26	$14.45	$22.91	$32.36
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $37.15 / $81.28 / $676.08	Facility	TC	$37.15	$81.28	$676.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $46.77 / $154.88	Professional		$32.36	$46.77	$154.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $15.14 / $40.74	Professional	26	$10.47	$15.14	$40.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $30.20 / $70.79	Professional	TC	$20.89	$30.20	$70.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $9.55 / $9.55	Professional	26	$9.55	$9.55	$9.55
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $27.54 / $27.54	Professional	TC	$27.54	$27.54	$27.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $66.07 / $128.82	Professional		$36.31	$66.07	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $20.89 / $38.02	Professional	26	$11.48	$20.89	$38.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $44.67 / $93.33	Professional	TC	$23.99	$44.67	$93.33
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $25.12 / $288.40	Facility	26	$15.49	$25.12	$288.40
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $50.12 / $288.40	Facility	TC	$30.20	$50.12	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $72.44 / $109.65	Professional		$38.02	$72.44	$109.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $23.44 / $32.36	Professional	26	$12.88	$23.44	$32.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $47.86 / $81.28	Professional	TC	$25.12	$47.86	$81.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $32.36 / $33.11	Professional		$19.95	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $25.12 / $25.70	Facility	26	$20.89	$25.12	$25.70
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $48.98 / $58.88 / $61.66	Facility	TC	$48.98	$58.88	$61.66
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $20.89 / $25.70	Professional	26	$15.14	$20.89	$25.70
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $58.88 / $61.66	Professional	TC	$48.98	$58.88	$61.66
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $17.38 / $17.38	Facility	26	$17.38	$17.38	$17.38
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $41.69 / $41.69 / $41.69	Facility	TC	$41.69	$41.69	$41.69
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $95.50 / $123.03	Professional		$58.88	$95.50	$123.03
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $28.18 / $38.02	Professional	26	$17.38	$28.18	$38.02
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $66.07 / $89.13	Professional	TC	$41.69	$66.07	$89.13
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 Facility Modifier TC Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	TC	$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $85.11 / $120.23	Professional		$60.26	$85.11	$120.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $26.92 / $35.48	Professional	26	$17.78	$26.92	$35.48
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $60.26 / $85.11	Professional	TC	$41.69	$60.26	$85.11
United Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $45.71 / $107.15	Professional		$36.31	$45.71	$107.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $14.79 / $33.11	Professional	26	$11.75	$14.79	$33.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $30.90 / $74.13	Professional	TC	$23.99	$30.90	$74.13
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 $12.59 / $14.45 / $23.99	Professional	26	$12.59	$14.45	$23.99
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $35.48 / $58.88	Professional	TC	$30.90	$35.48	$58.88