Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $25.70 / $51.29	Professional		$20.89	$25.70	$51.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $20.89 / $25.70	Professional	26	$16.98	$20.89	$25.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $3.02 / $3.98 / $25.70	Professional	TC	$3.02	$3.98	$25.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $24.55 / $24.55	Professional		$24.55	$24.55	$24.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $41.69 / $77.62	Professional		$22.91	$41.69	$77.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $28.84 / $61.66	Professional	26	$18.62	$28.84	$61.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $3.47 / $6.92 / $33.88	Professional	TC	$3.47	$6.92	$33.88
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $28.18 / $52.48	Facility	26	$19.05	$28.18	$52.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $39.81 / $69.18	Professional		$24.55	$39.81	$69.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $27.54 / $48.98	Professional	26	$19.05	$27.54	$48.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $3.98 / $9.33 / $38.90	Professional	TC	$3.98	$9.33	$38.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $2.88 / $15.85 / $33.11	Professional		$2.88	$15.85	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $39.81 / $41.69	Facility	26	$33.88	$39.81	$41.69
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $33.88 / $45.71	Professional	26	$23.99	$33.88	$45.71
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $4.90 / $8.71 / $52.48	Professional	TC	$4.90	$8.71	$52.48
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $27.54 / $27.54	Facility	26	$27.54	$27.54	$27.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $58.88 / $72.44	Professional		$35.48	$58.88	$72.44
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $48.98 / $60.26	Professional	26	$28.84	$48.98	$60.26
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $6.17 / $10.23 / $12.59	Professional	TC	$6.17	$10.23	$12.59
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $25.70 / $50.12	Professional		$25.70	$25.70	$50.12
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $21.38 / $41.69	Professional	26	$20.89	$21.38	$41.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $4.47 / $4.79 / $8.71	Professional	TC	$4.47	$4.79	$8.71
United Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $40.74 / $72.44	Professional		$26.30	$40.74	$72.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $30.90 / $57.54	Professional	26	$20.89	$30.90	$57.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $4.17 / $7.08 / $37.15	Professional	TC	$4.17	$7.08	$37.15
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $28.84 / $35.48	Professional		$25.12	$28.84	$35.48
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $23.99 / $29.51	Professional	26	$20.89	$23.99	$29.51
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $4.47 / $5.13 / $6.31	Professional	TC	$4.47	$5.13	$6.31