Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $199.53 / $467.74	Facility		$38.90	$199.53	$467.74
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $11.48 / $23.99	Facility	26	$9.55	$11.48	$23.99
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $162.18 / $537.03	Facility	TC	$28.84	$162.18	$537.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.48 / $39.81 / $134.90	Professional		$11.48	$39.81	$134.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $14.13 / $43.65	Professional	26	$7.76	$14.13	$43.65
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $20.42 / $79.43 / $239.88	Professional	50	$20.42	$79.43	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $37.15 / $95.50	Professional	TC	$20.42	$37.15	$95.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $54.95 / $69.18	Professional		$23.99	$54.95	$69.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $14.13 / $16.22	Professional	26	$8.91	$14.13	$16.22
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $109.65 / $109.65 / $109.65	Professional	50	$109.65	$109.65	$109.65
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $38.90 / $48.98	Professional	TC	$25.12	$38.90	$48.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $309.03 / $371.54	Facility		$144.54	$309.03	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $52.48 / $100.00	Professional		$28.18	$52.48	$100.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $13.49 / $24.55	Professional	26	$7.41	$13.49	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $38.90 / $75.86	Professional	TC	$20.42	$38.90	$75.86
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $37.15 / $64.57 / $165.96	Facility		$37.15	$64.57	$165.96
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $16.60 / $165.96	Facility	26	$9.33	$16.60	$165.96
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $27.54 / $46.77 / $165.96	Facility	TC	$27.54	$46.77	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $58.88 / $85.11	Professional		$32.36	$58.88	$85.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $15.14 / $21.38	Professional	26	$8.13	$15.14	$21.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $44.67 / $66.07	Professional	TC	$23.99	$44.67	$66.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $16.22 / $32.36 / $33.11	Professional		$16.22	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $61.66 / $66.07	Facility		$48.98	$61.66	$66.07
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $16.60 / $16.60	Facility	26	$13.80	$16.60	$16.60
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $36.31 / $45.71 / $50.12	Facility	TC	$36.31	$45.71	$50.12
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $38.02 / $38.02	Professional		$38.02	$38.02	$38.02
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.45 / $17.78	Professional	26	$10.00	$14.45	$17.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $40.74 / $50.12	Professional	TC	$26.30	$40.74	$50.12
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $43.65 / $45.71	Facility		$43.65	$43.65	$45.71
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $11.22 / $11.22 / $11.48	Facility	26	$11.22	$11.22	$11.48
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $32.36 / $32.36 / $33.88	Facility	TC	$32.36	$32.36	$33.88
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $72.44 / $95.50	Professional		$45.71	$72.44	$95.50
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $18.20 / $24.55	Professional	26	$11.48	$18.20	$24.55
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $53.70 / $72.44	Professional	TC	$33.88	$53.70	$72.44
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 $46.77 / $66.07 / $91.20	Professional		$46.77	$66.07	$91.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $17.78 / $23.44	Professional	26	$11.75	$17.78	$23.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $48.98 / $69.18	Professional	TC	$33.11	$48.98	$69.18
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 / $81.28	Professional		$28.84	$35.48	$81.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $9.33 / $21.88	Professional	26	$7.59	$9.33	$21.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $26.30 / $60.26	Professional	TC	$21.38	$26.30	$60.26
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $39.81 / $66.07	Professional		$34.67	$39.81	$66.07
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 $25.70 / $29.51 / $48.98	Professional	TC	$25.70	$29.51	$48.98