Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $38.90 / $51.29	Facility	26	$28.18	$38.90	$51.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $40.74 / $147.91	Professional		$30.90	$40.74	$147.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $27.54 / $97.72	Professional	26	$20.42	$27.54	$97.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $12.02 / $25.12	Professional	TC	$10.00	$12.02	$25.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $46.77 / $70.79	Professional		$28.84	$46.77	$70.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $33.88 / $45.71	Professional	26	$21.88	$33.88	$45.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $56.23 / $102.33	Professional		$34.67	$56.23	$102.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $36.31 / $64.57	Professional	26	$22.91	$36.31	$64.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $11.75 / $19.50 / $37.15	Professional	TC	$11.75	$19.50	$37.15
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $32.36 / $61.66	Facility	26	$20.89	$32.36	$61.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $47.86 / $79.43	Professional		$30.90	$47.86	$79.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $30.90 / $51.29	Professional	26	$20.89	$30.90	$51.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $10.23 / $16.22 / $28.18	Professional	TC	$10.23	$16.22	$28.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $13.80 / $32.36 / $33.11	Professional		$13.80	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $42.66 / $43.65	Facility	26	$35.48	$42.66	$43.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $35.48 / $43.65	Professional	26	$26.30	$35.48	$43.65
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $20.42 / $24.55	Professional	TC	$16.22	$20.42	$24.55
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $29.51 / $29.51	Facility	26	$29.51	$29.51	$29.51
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $69.18 / $100.00	Professional		$46.77	$69.18	$100.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $43.65 / $63.10	Professional	26	$29.51	$43.65	$63.10
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $25.12 / $37.15	Professional	TC	$16.98	$25.12	$37.15
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $218.78 / $218.78 / $218.78	Facility	26	$218.78	$218.78	$218.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $63.10 / $81.28	Professional		$45.71	$63.10	$81.28
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $40.74 / $53.70	Professional	26	$30.20	$40.74	$53.70
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $20.89 / $28.84	Professional	TC	$15.14	$20.89	$28.84
United Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $48.98 / $85.11	Professional		$33.11	$48.98	$85.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $33.11 / $56.23	Professional	26	$21.88	$33.11	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.72 / $16.22 / $28.18	Professional	TC	$10.72	$16.22	$28.18
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $43.65 / $72.44	Professional		$38.02	$43.65	$72.44
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $26.30 / $43.65	Professional	26	$22.91	$26.30	$43.65
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $17.38 / $28.84	Professional	TC	$15.14	$17.38	$28.84