Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $51.29 / $181.97	Professional		$21.88	$51.29	$181.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.01 / $19.50 / $52.48	Professional	26	$5.01	$19.50	$52.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $34.67 / $79.43	Professional	TC	$14.13	$34.67	$79.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $28.18 / $66.07	Professional		$19.95	$28.18	$66.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $3.55 / $7.08 / $13.49	Professional	26	$3.55	$7.08	$13.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $31.62 / $31.62	Professional	TC	$31.62	$31.62	$31.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $34.67 / $45.71	Professional		$15.85	$34.67	$45.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.63 / $6.76 / $10.00	Professional	26	$3.63	$6.76	$10.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.30 / $27.54 / $35.48	Professional	TC	$12.30	$27.54	$35.48
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $74.13 / $114.82	Facility		$38.02	$74.13	$114.82
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $15.85 / $114.82	Facility	26	$9.55	$15.85	$114.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $70.79 / $95.50	Professional		$44.67	$70.79	$95.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $13.80 / $19.05	Professional	26	$9.55	$13.80	$19.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $56.23 / $79.43	Professional	TC	$34.67	$56.23	$79.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $32.36 / $33.11	Professional		$17.78	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $61.66 / $77.62	Facility		$50.12	$61.66	$77.62
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $13.18 / $14.13	Facility	26	$10.23	$13.18	$14.13
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $10.96 / $14.13	Professional	26	$7.41	$10.96	$14.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $43.65 / $77.62	Professional	TC	$26.30	$43.65	$77.62
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $72.44 / $89.13	Professional		$45.71	$72.44	$89.13
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $15.14 / $18.20	Professional	26	$9.33	$15.14	$18.20
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $56.23 / $72.44	Professional	TC	$36.31	$56.23	$72.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $58.88 / $81.28	Professional		$42.66	$58.88	$81.28
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $12.30 / $15.49	Professional	26	$9.33	$12.30	$15.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $46.77 / $70.79	Professional	TC	$33.88	$46.77	$70.79
United Facility/Professional Facility Modifier Low / Median / High Price $10.00 / $15.14 / $25.12	Facility		$10.00	$15.14	$25.12
United Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $31.62 / $64.57	Professional		$19.05	$31.62	$64.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $4.07 / $6.61 / $14.79	Professional	26	$4.07	$6.61	$14.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $23.99 / $48.98	Professional	TC	$14.45	$23.99	$48.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $33.88 / $33.88	Professional		$33.88	$33.88	$33.88
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $6.76 / $6.76	Professional	26	$6.76	$6.76	$6.76
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $26.92 / $26.92	Professional	TC	$26.92	$26.92	$26.92