Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $12.88 / $35.48 / $147.91	Facility		$12.88	$35.48	$147.91
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $17.38 / $34.67	Facility	26	$8.91	$17.38	$34.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $14.79 / $40.74	Professional		$9.77	$14.79	$40.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $8.91 / $42.66	Professional	26	$6.03	$8.91	$42.66
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $11.48 / $11.48 / $12.30	Professional	50	$11.48	$11.48	$12.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $2.69 / $3.98 / $11.48	Professional	TC	$2.69	$3.98	$11.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $8.71 / $16.22 / $22.91	Professional		$8.71	$16.22	$22.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $13.80 / $15.49	Professional	26	$13.49	$13.80	$15.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $97.72 / $123.03	Facility		$35.48	$97.72	$123.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $1.86 / $8.71 / $12.30	Facility	26	$1.86	$8.71	$12.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $12.59 / $20.42 / $35.48	Professional		$12.59	$20.42	$35.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $13.49 / $23.44	Professional	26	$8.51	$13.49	$23.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $3.63 / $6.46 / $12.02	Professional	TC	$3.63	$6.46	$12.02
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $15.14 / $25.12 / $67.61	Facility		$15.14	$25.12	$67.61
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $10.72 / $16.22 / $67.61	Facility	26	$10.72	$16.22	$67.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $14.79 / $23.99 / $33.88	Professional		$14.79	$23.99	$33.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $15.49 / $21.38	Professional	26	$9.77	$15.49	$21.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $4.90 / $8.32 / $12.30	Professional	TC	$4.90	$8.32	$12.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $7.41 / $32.36 / $33.11	Professional		$7.41	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $18.62 / $21.88 / $28.84	Facility		$18.62	$21.88	$28.84
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $15.14 / $18.62	Facility	26	$12.59	$15.14	$18.62
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $15.85 / $19.50	Professional	26	$10.72	$15.85	$19.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $5.13 / $7.59 / $10.23	Professional	TC	$5.13	$7.59	$10.23
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $15.49 / $15.49 / $15.49	Facility		$15.49	$15.49	$15.49
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $10.47 / $10.47	Facility	26	$10.47	$10.47	$10.47
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $15.49 / $25.12 / $33.11	Professional		$15.49	$25.12	$33.11
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $17.38 / $22.39	Professional	26	$10.47	$17.38	$22.39
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $5.01 / $8.32 / $10.96	Professional	TC	$5.01	$8.32	$10.96
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $83.18 / $162.18	Facility		$53.70	$83.18	$162.18
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $47.86 / $47.86	Facility	26	$47.86	$47.86	$47.86
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $23.44 / $32.36	Professional		$15.85	$23.44	$32.36
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $15.85 / $21.38	Professional	26	$10.72	$15.85	$21.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $5.13 / $7.59 / $10.47	Professional	TC	$5.13	$7.59	$10.47
United Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $109.65 / $194.98	Facility		$81.28	$109.65	$194.98
United Facility/Professional Professional Modifier Low / Median / High Price $11.48 / $14.45 / $29.51	Professional		$11.48	$14.45	$29.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $9.55 / $19.95	Professional	26	$8.13	$9.55	$19.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $3.63 / $4.47 / $10.47	Professional	TC	$3.63	$4.47	$10.47
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $3.02 / $13.80 / $22.91	Professional		$3.02	$13.80	$22.91
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $8.91 / $14.79	Professional	26	$7.76	$8.91	$14.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $4.07 / $4.79 / $7.76	Professional	TC	$4.07	$4.79	$7.76