Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $257.04 / $537.03	Facility		$45.71	$257.04	$537.03
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $12.59 / $33.11	Facility	26	$10.23	$12.59	$33.11
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.90 / $165.96 / $691.83	Facility	TC	$30.90	$165.96	$691.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.23 / $41.69 / $125.89	Professional		$10.23	$41.69	$125.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $12.88 / $47.86	Professional	26	$8.32	$12.88	$47.86
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $19.05 / $72.44 / $208.93	Professional	50	$19.05	$72.44	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $39.81 / $93.33	Professional	TC	$20.89	$39.81	$93.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $57.54 / $74.13	Professional		$27.54	$57.54	$74.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $14.45 / $18.20	Professional	26	$6.92	$14.45	$18.20
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $38.90 / $38.90 / $117.49	Professional	50	$38.90	$38.90	$117.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $44.67 / $56.23	Professional	TC	$29.51	$44.67	$56.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $154.88 / $309.03 / $371.54	Facility		$154.88	$309.03	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $51.29 / $104.71	Professional		$28.84	$51.29	$104.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $14.45 / $26.92	Professional	26	$8.13	$14.45	$26.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $37.15 / $79.43	Professional	TC	$19.50	$37.15	$79.43
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $33.88 / $61.66 / $165.96	Facility		$33.88	$61.66	$165.96
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $17.78 / $165.96	Facility	26	$10.23	$17.78	$165.96
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $23.99 / $42.66 / $165.96	Facility	TC	$23.99	$42.66	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $56.23 / $91.20	Professional		$29.51	$56.23	$91.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $16.60 / $22.91	Professional	26	$9.12	$16.60	$22.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $39.81 / $69.18	Professional	TC	$20.42	$39.81	$69.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $32.36 / $33.11	Professional		$17.38	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $61.66 / $70.79	Facility		$44.67	$61.66	$70.79
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $17.78 / $18.20	Facility	26	$14.79	$17.78	$18.20
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $31.62 / $44.67 / $52.48	Facility	TC	$31.62	$44.67	$52.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $15.85 / $19.50	Professional	26	$10.96	$15.85	$19.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $33.88 / $46.77	Professional	TC	$23.99	$33.88	$46.77
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $46.77 / $47.86	Facility		$46.77	$46.77	$47.86
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $34.67 / $34.67 / $35.48	Facility	TC	$34.67	$34.67	$35.48
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $77.62 / $100.00	Professional		$47.86	$77.62	$100.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $19.95 / $26.92	Professional	26	$12.30	$19.95	$26.92
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $57.54 / $74.13	Professional	TC	$35.48	$57.54	$74.13
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $158.49 / $251.19 / $489.78	Facility		$158.49	$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 $47.86 / $69.18 / $97.72	Professional		$47.86	$69.18	$97.72
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $19.05 / $25.12	Professional	26	$12.88	$19.05	$25.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $51.29 / $72.44	Professional	TC	$35.48	$51.29	$72.44
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 $28.84 / $35.48 / $87.10	Professional		$28.84	$35.48	$87.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $10.23 / $23.44	Professional	26	$8.32	$10.23	$23.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $26.30 / $63.10	Professional	TC	$19.50	$26.30	$63.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $42.66 / $70.79	Professional		$37.15	$42.66	$70.79
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $10.47 / $17.38	Professional	26	$9.12	$10.47	$17.38
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $32.36 / $53.70	Professional	TC	$28.18	$32.36	$53.70