Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $218.78 / $524.81	Facility		$44.67	$218.78	$524.81
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.75 / $15.49 / $93.33	Facility	26	$11.75	$15.49	$93.33
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $199.53 / $616.60	Facility	TC	$28.84	$199.53	$616.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $47.86 / $144.54	Professional		$28.84	$47.86	$144.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $14.45 / $48.98	Professional	26	$9.33	$14.45	$48.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $28.18 / $74.13	Professional	TC	$19.05	$28.18	$74.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $33.88 / $69.18	Professional		$23.44	$33.88	$69.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $16.22 / $20.42	Professional	26	$7.76	$16.22	$20.42
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $38.90 / $52.48	Professional	TC	$21.88	$38.90	$52.48
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 $28.18 / $51.29 / $100.00	Professional		$28.18	$51.29	$100.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $16.98 / $30.90	Professional	26	$9.33	$16.98	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $34.67 / $72.44	Professional	TC	$18.62	$34.67	$72.44
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $60.26 / $229.09	Facility		$36.31	$60.26	$229.09
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $20.42 / $229.09	Facility	26	$12.30	$20.42	$229.09
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $23.44 / $38.90 / $229.09	Facility	TC	$23.44	$38.90	$229.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $56.23 / $87.10	Professional		$30.20	$56.23	$87.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $19.05 / $26.30	Professional	26	$10.23	$19.05	$26.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $37.15 / $61.66	Professional	TC	$19.50	$37.15	$61.66
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 $44.67 / $66.07 / $67.61	Facility		$44.67	$66.07	$67.61
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $20.42 / $20.89	Facility	26	$16.98	$20.42	$20.89
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $38.90 / $45.71 / $46.77	Facility	TC	$38.90	$45.71	$46.77
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $16.98 / $20.42	Professional	26	$12.30	$16.98	$20.42
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $42.66 / $46.77	Professional	TC	$34.67	$42.66	$46.77
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $45.71 / $45.71	Facility		$45.71	$45.71	$45.71
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $14.13 / $14.13	Facility	26	$14.13	$14.13	$14.13
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $30.90 / $30.90 / $32.36	Facility	TC	$30.90	$30.90	$32.36
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $74.13 / $97.72	Professional		$45.71	$74.13	$97.72
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $22.91 / $30.90	Professional	26	$14.13	$22.91	$30.90
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $51.29 / $70.79	Professional	TC	$32.36	$51.29	$70.79
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 $45.71 / $66.07 / $93.33	Professional		$45.71	$66.07	$93.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $21.88 / $28.84	Professional	26	$14.79	$21.88	$28.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $45.71 / $66.07	Professional	TC	$31.62	$45.71	$66.07
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 $28.18 / $36.31 / $85.11	Professional		$28.18	$36.31	$85.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $11.75 / $26.92	Professional	26	$9.55	$11.75	$26.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $23.99 / $57.54	Professional	TC	$18.62	$23.99	$57.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $39.81 / $64.57	Professional		$34.67	$39.81	$64.57
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $11.75 / $19.50	Professional	26	$10.23	$11.75	$19.50
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $27.54 / $45.71	Professional	TC	$23.99	$27.54	$45.71