Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $22.91 / $41.69	Facility	26	$16.98	$22.91	$41.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $66.07 / $138.04	Professional		$37.15	$66.07	$138.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $15.49 / $46.77	Professional	26	$7.76	$15.49	$46.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $34.67 / $95.50	Professional	TC	$21.88	$34.67	$95.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $25.12 / $31.62	Professional	26	$14.13	$25.12	$31.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $83.18 / $138.04	Professional		$42.66	$83.18	$138.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $18.20 / $41.69	Professional	26	$8.91	$18.20	$41.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $60.26 / $104.71	Professional	TC	$27.54	$60.26	$104.71
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $19.95 / $302.00	Facility	26	$9.77	$19.95	$302.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $93.33 / $134.90	Professional		$51.29	$93.33	$134.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $17.38 / $34.67	Professional	26	$8.13	$17.38	$34.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $70.79 / $104.71	Professional	TC	$41.69	$70.79	$104.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $18.62 / $32.36 / $33.11	Professional		$18.62	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $25.70 / $29.51	Facility	26	$14.13	$25.70	$29.51
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $15.85 / $29.51	Professional	26	$11.22	$15.85	$29.51
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $66.07 / $97.72	Professional	TC	$41.69	$66.07	$97.72
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $19.95 / $20.42	Facility	26	$19.95	$19.95	$20.42
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $95.50 / $125.89	Professional		$58.88	$95.50	$125.89
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $32.36 / $43.65	Professional	26	$19.95	$32.36	$43.65
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $63.10 / $83.18	Professional	TC	$38.02	$63.10	$83.18
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	26	$446.68	$446.68	$446.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $91.20 / $120.23	Professional		$58.88	$91.20	$120.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $30.20 / $41.69	Professional	26	$18.62	$30.20	$41.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $58.88 / $83.18	Professional	TC	$39.81	$58.88	$83.18
United Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $57.54 / $120.23	Professional		$42.66	$57.54	$120.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $15.85 / $38.90	Professional	26	$8.71	$15.85	$38.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $42.66 / $89.13	Professional	TC	$26.92	$42.66	$89.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $52.48 / $87.10	Professional		$45.71	$52.48	$87.10
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $17.78 / $29.51	Professional	26	$15.49	$17.78	$29.51
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $34.67 / $57.54	Professional	TC	$30.20	$34.67	$57.54