Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $18.62 / $38.02	Facility	26	$16.98	$18.62	$38.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $38.90 / $112.20	Professional		$16.98	$38.90	$112.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $17.38 / $51.29	Professional	26	$7.94	$17.38	$51.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $25.12 / $54.95	Professional	TC	$10.00	$25.12	$54.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $83.18 / $83.18	Professional		$83.18	$83.18	$83.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $25.70 / $30.20	Professional	26	$11.22	$25.70	$30.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $45.71 / $123.03	Professional		$19.95	$45.71	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $17.78 / $42.66	Professional	26	$8.32	$17.78	$42.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $30.90 / $83.18	Professional	TC	$10.96	$30.90	$83.18
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $19.05 / $1,380.38	Facility	26	$9.33	$19.05	$1,380.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $36.31 / $109.65	Professional		$17.78	$36.31	$109.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $16.22 / $35.48	Professional	26	$7.59	$16.22	$35.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $10.47 / $19.50 / $70.79	Professional	TC	$10.47	$19.50	$70.79
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 $13.18 / $25.70 / $30.20	Facility	26	$13.18	$25.70	$30.20
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $17.38 / $17.38	Professional		$17.38	$17.38	$17.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $14.13 / $29.51	Professional	26	$9.33	$14.13	$29.51
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $16.60 / $51.29	Professional	TC	$10.96	$16.60	$51.29
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $20.42 / $20.42 / $20.42	Facility	26	$20.42	$20.42	$20.42
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $93.33 / $125.89	Professional		$58.88	$93.33	$125.89
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $33.11 / $44.67	Professional	26	$20.42	$33.11	$44.67
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $60.26 / $81.28	Professional	TC	$38.02	$60.26	$81.28
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $933.25 / $933.25 / $933.25	Facility	26	$933.25	$933.25	$933.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $83.18 / $117.49	Professional		$36.31	$83.18	$117.49
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $29.51 / $42.66	Professional	26	$16.98	$29.51	$42.66
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $53.70 / $75.86	Professional	TC	$19.05	$53.70	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $43.65 / $104.71	Professional		$19.50	$43.65	$104.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $16.22 / $38.90	Professional	26	$8.32	$16.22	$38.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.22 / $27.54 / $67.61	Professional	TC	$11.22	$27.54	$67.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $51.29 / $85.11	Professional		$44.67	$51.29	$85.11
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $16.98 / $28.18	Professional	26	$14.79	$16.98	$28.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $33.88 / $56.23	Professional	TC	$29.51	$33.88	$56.23