Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $32.36 / $263.03 / $575.44	Facility		$32.36	$263.03	$575.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $11.48 / $23.99	Facility	26	$10.00	$11.48	$23.99
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $20.89 / $213.80 / $630.96	Facility	TC	$20.89	$213.80	$630.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $28.84 / $104.71	Professional		$17.78	$28.84	$104.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $9.77 / $38.90	Professional	26	$7.94	$9.77	$38.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $18.20 / $43.65	Professional	TC	$10.00	$18.20	$43.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $28.18 / $60.26	Professional		$20.42	$28.18	$60.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $13.80 / $16.60	Professional	26	$7.08	$13.80	$16.60
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $13.18 / $25.12 / $39.81	Professional	TC	$13.18	$25.12	$39.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $295.12 / $371.54	Facility		$125.89	$295.12	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $37.15 / $75.86	Professional		$19.50	$37.15	$75.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $14.13 / $24.55	Professional	26	$7.76	$14.13	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $22.39 / $52.48	Professional	TC	$10.96	$22.39	$52.48
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $23.44 / $45.71 / $229.09	Facility		$23.44	$45.71	$229.09
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $16.60 / $229.09	Facility	26	$10.23	$16.60	$229.09
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $13.49 / $26.30 / $229.09	Facility	TC	$13.49	$26.30	$229.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $38.90 / $66.07	Professional		$20.89	$38.90	$66.07
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $15.85 / $21.88	Professional	26	$8.51	$15.85	$21.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $12.30 / $24.55 / $45.71	Professional	TC	$12.30	$24.55	$45.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $51.29 / $51.29	Facility		$36.31	$51.29	$51.29
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $16.60 / $17.38	Facility	26	$13.80	$16.60	$17.38
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $33.88 / $34.67	Facility	TC	$28.84	$33.88	$34.67
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $13.80 / $16.60	Professional	26	$10.96	$13.80	$16.60
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $30.20 / $33.88	Professional	TC	$26.92	$30.20	$33.88
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $34.67 / $35.48	Facility		$34.67	$34.67	$35.48
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $11.48 / $11.75	Facility	26	$11.48	$11.48	$11.75
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $22.91 / $22.91 / $23.99	Facility	TC	$22.91	$22.91	$23.99
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $56.23 / $75.86	Professional		$35.48	$56.23	$75.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $18.62 / $25.12	Professional	26	$11.48	$18.62	$25.12
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $38.90 / $52.48	Professional	TC	$23.99	$38.90	$52.48
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $251.19 / $489.78	Facility		$165.96	$251.19	$489.78
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $158.49 / $158.49 / $158.49	Facility	26	$158.49	$158.49	$158.49
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $158.49 / $158.49 / $158.49	Facility	TC	$158.49	$158.49	$158.49
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $51.29 / $72.44	Professional		$35.48	$51.29	$72.44
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $18.20 / $23.99	Professional	26	$12.02	$18.20	$23.99
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $34.67 / $48.98	Professional	TC	$21.88	$34.67	$48.98
United Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $331.13 / $588.84	Facility		$245.47	$331.13	$588.84
United Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $27.54 / $66.07	Professional		$19.05	$27.54	$66.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $9.77 / $22.39	Professional	26	$7.94	$9.77	$22.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.72 / $17.38 / $43.65	Professional	TC	$10.72	$17.38	$43.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $30.20 / $50.12	Professional		$26.30	$30.20	$50.12
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $9.77 / $16.22	Professional	26	$8.51	$9.77	$16.22
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $20.42 / $33.88	Professional	TC	$17.78	$20.42	$33.88