Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.88 / $21.88 / $74.13	Professional		$12.88	$21.88	$74.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $28.84 / $79.43	Professional	26	$8.91	$28.84	$79.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $5.01 / $8.91 / $24.55	Professional	TC	$5.01	$8.91	$24.55
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $10.00 / $16.98 / $16.98	Professional		$10.00	$16.98	$16.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $19.50 / $20.89	Professional	26	$5.75	$19.50	$20.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $9.77 / $9.77 / $9.77	Professional	TC	$9.77	$9.77	$9.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $10.00 / $20.89 / $30.20	Professional		$10.00	$20.89	$30.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $12.02 / $17.38	Professional	26	$6.46	$12.02	$17.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $4.17 / $8.91 / $11.75	Professional	TC	$4.17	$8.91	$11.75
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $25.70 / $41.69 / $54.95	Facility		$25.70	$41.69	$54.95
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $15.85 / $24.55 / $32.36	Facility	26	$15.85	$24.55	$32.36
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $9.33 / $16.98 / $22.91	Facility	TC	$9.33	$16.98	$22.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $42.66 / $58.88	Professional		$26.92	$42.66	$58.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $24.55 / $33.11	Professional	26	$16.98	$24.55	$33.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $18.62 / $25.70	Professional	TC	$10.96	$18.62	$25.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $7.59 / $32.36 / $33.11	Professional		$7.59	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $39.81 / $42.66	Facility		$30.20	$39.81	$42.66
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $18.20 / $23.44 / $24.55	Facility	26	$18.20	$23.44	$24.55
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $11.22 / $16.22 / $17.38	Facility	TC	$11.22	$16.22	$17.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $19.95 / $25.70	Professional	26	$15.85	$19.95	$25.70
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $9.12 / $12.88 / $17.38	Professional	TC	$9.12	$12.88	$17.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $45.71 / $56.23	Professional		$27.54	$45.71	$56.23
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $26.30 / $33.11	Professional	26	$16.22	$26.30	$33.11
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $11.75 / $19.50 / $22.91	Professional	TC	$11.75	$19.50	$22.91
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $37.15 / $46.77	Professional		$28.18	$37.15	$46.77
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $22.39 / $26.92	Professional	26	$16.60	$22.39	$26.92
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $10.47 / $15.49 / $19.95	Professional	TC	$10.47	$15.49	$19.95
United Facility/Professional Facility Modifier Low / Median / High Price $7.24 / $10.96 / $18.20	Facility		$7.24	$10.96	$18.20
United Facility/Professional Professional Modifier Low / Median / High Price $12.30 / $18.62 / $44.67	Professional		$12.30	$18.62	$44.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $11.48 / $26.30	Professional	26	$7.24	$11.48	$26.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $5.13 / $7.59 / $18.20	Professional	TC	$5.13	$7.59	$18.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $20.42 / $20.42	Professional		$20.42	$20.42	$20.42
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $11.48 / $11.48	Professional	26	$11.48	$11.48	$11.48
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $8.71 / $8.71 / $8.71	Professional	TC	$8.71	$8.71	$8.71