Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.44 / $44.67 / $81.28	Facility	26	$23.44	$44.67	$81.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $72.44 / $190.55	Professional		$34.67	$72.44	$190.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $33.88 / $97.72	Professional	26	$21.88	$33.88	$97.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.88 / $33.88 / $87.10	Professional	TC	$12.88	$33.88	$87.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Professional		$109.65	$109.65	$109.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $25.70 / $48.98	Professional	26	$20.42	$25.70	$48.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $95.50 / $138.04	Professional		$58.88	$95.50	$138.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $47.86 / $72.44	Professional	26	$29.51	$47.86	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $44.67 / $79.43	Professional	TC	$24.55	$44.67	$79.43
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $53.70 / $588.84	Facility	26	$30.20	$53.70	$588.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $97.72 / $147.91	Professional		$57.54	$97.72	$147.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $52.48 / $64.57	Professional	26	$30.20	$52.48	$64.57
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $41.69 / $89.13	Professional	TC	$23.99	$41.69	$89.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.49 / $32.36 / $33.11	Professional		$15.49	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $47.86 / $48.98	Facility	26	$38.90	$47.86	$48.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $42.66 / $52.48	Professional	26	$30.90	$42.66	$52.48
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $72.44 / $93.33	Professional	TC	$27.54	$72.44	$93.33
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $31.62 / $32.36	Facility	26	$31.62	$31.62	$32.36
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $87.10 / $120.23	Professional		$53.70	$87.10	$120.23
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $53.70 / $69.18	Professional	26	$32.36	$53.70	$69.18
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $33.88 / $48.98	Professional	TC	$21.38	$33.88	$48.98
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $245.47 / $245.47 / $245.47	Facility	26	$245.47	$245.47	$245.47
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $81.28 / $123.03	Professional		$52.48	$81.28	$123.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $50.12 / $67.61	Professional	26	$32.36	$50.12	$67.61
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $32.36 / $46.77	Professional	TC	$19.95	$32.36	$46.77
United Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $81.28 / $114.82	Professional		$46.77	$81.28	$114.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $32.36 / $61.66	Professional	26	$22.39	$32.36	$61.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $35.48 / $67.61	Professional	TC	$18.20	$35.48	$67.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $56.23 / $79.43	Professional		$41.69	$56.23	$79.43
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $32.36 / $45.71	Professional	26	$23.99	$32.36	$45.71
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $23.99 / $33.88	Professional	TC	$17.78	$23.99	$33.88