Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.91 / $15.85 / $47.86	Professional		$8.91	$15.85	$47.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.24 / $6.76 / $28.84	Professional	26	$2.24	$6.76	$28.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $6.03 / $12.02 / $35.48	Professional	TC	$6.03	$12.02	$35.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $2.09 / $7.41 / $8.51	Professional	26	$2.09	$7.41	$8.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $8.32 / $16.60 / $22.91	Professional		$8.32	$16.60	$22.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.19 / $4.37 / $6.46	Professional	26	$2.19	$4.37	$6.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $5.89 / $12.30 / $16.22	Professional	TC	$5.89	$12.30	$16.22
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $20.42 / $37.15 / $114.82	Facility		$20.42	$37.15	$114.82
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $6.31 / $10.23 / $114.82	Facility	26	$6.31	$10.23	$114.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $33.88 / $46.77	Professional		$20.42	$33.88	$46.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $8.71 / $12.02	Professional	26	$6.31	$8.71	$12.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $25.70 / $35.48	Professional	TC	$14.45	$25.70	$35.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $8.13 / $32.36 / $33.11	Professional		$8.13	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $26.30 / $30.90 / $41.69	Facility		$26.30	$30.90	$41.69
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $6.31 / $8.51 / $8.91	Facility	26	$6.31	$8.51	$8.91
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $5.89 / $7.59 / $9.33	Professional	26	$5.89	$7.59	$9.33
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $19.05 / $30.90	Professional	TC	$14.13	$19.05	$30.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $35.48 / $43.65	Professional		$22.39	$35.48	$43.65
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $9.77 / $12.02	Professional	26	$6.03	$9.77	$12.02
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $25.70 / $32.36	Professional	TC	$16.22	$25.70	$32.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $28.84 / $39.81	Professional		$20.89	$28.84	$39.81
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $7.94 / $10.00	Professional	26	$6.03	$7.94	$10.00
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $20.89 / $32.36	Professional	TC	$14.79	$20.89	$32.36
United Facility/Professional Facility Modifier Low / Median / High Price $5.25 / $7.94 / $13.18	Facility		$5.25	$7.94	$13.18
United Facility/Professional Professional Modifier Low / Median / High Price $9.55 / $15.85 / $32.36	Professional		$9.55	$15.85	$32.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $2.63 / $4.37 / $9.55	Professional	26	$2.63	$4.37	$9.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $6.76 / $11.22 / $22.91	Professional	TC	$6.76	$11.22	$22.91
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $16.98 / $16.98	Professional		$16.98	$16.98	$16.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $4.37 / $4.37 / $4.37	Professional	26	$4.37	$4.37	$4.37
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $12.59 / $12.59 / $12.59	Professional	TC	$12.59	$12.59	$12.59