Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.22 / $12.02 / $24.55	Facility	26	$11.22	$12.02	$24.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $66.07 / $199.53	Professional		$51.29	$66.07	$199.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.47 / $34.67	Professional	26	$7.94	$10.47	$34.67
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $8.13 / $8.32 / $39.81	Professional	52	$8.13	$8.32	$39.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $52.48 / $104.71	Professional	TC	$42.66	$52.48	$104.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $60.26 / $144.54	Professional		$42.66	$60.26	$144.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $16.22 / $19.05	Professional	26	$9.55	$16.22	$19.05
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $95.50 / $95.50	Professional	TC	$95.50	$95.50	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $93.33 / $173.78	Professional		$58.88	$93.33	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $14.13 / $25.70	Professional	26	$9.12	$14.13	$25.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $77.62 / $147.91	Professional	TC	$50.12	$77.62	$147.91
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $8.71 / $12.59 / $21.38	Facility	26	$8.71	$12.59	$21.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $81.28 / $141.25	Professional		$53.70	$81.28	$141.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $12.30 / $20.42	Professional	26	$8.13	$12.30	$20.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $67.61 / $120.23	Professional	TC	$45.71	$67.61	$120.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $6.76 / $32.36 / $37.15	Professional		$6.76	$32.36	$37.15
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $16.98 / $17.38	Facility	26	$14.45	$16.98	$17.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $14.79 / $19.05	Professional	26	$10.47	$14.79	$19.05
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $77.62 / $97.72	Professional	TC	$58.88	$77.62	$97.72
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $11.75 / $11.75 / $11.75	Facility	26	$11.75	$11.75	$11.75
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $114.82 / $162.18	Professional		$77.62	$114.82	$162.18
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $17.78 / $25.12	Professional	26	$11.75	$17.78	$25.12
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $97.72 / $138.04	Professional	TC	$66.07	$97.72	$138.04
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $104.71 / $134.90	Professional		$79.43	$104.71	$134.90
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $16.60 / $21.88	Professional	26	$12.02	$16.60	$21.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $89.13 / $114.82	Professional	TC	$67.61	$89.13	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $81.28 / $141.25	Professional		$54.95	$81.28	$141.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $12.88 / $22.39	Professional	26	$8.91	$12.88	$22.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $69.18 / $120.23	Professional	TC	$45.71	$69.18	$120.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $75.86 / $125.89	Professional		$66.07	$75.86	$125.89
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $10.96 / $18.20	Professional	26	$9.55	$10.96	$18.20
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $66.07 / $107.15	Professional	TC	$56.23	$66.07	$107.15