Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $154.88 / $489.78	Facility		$34.67	$154.88	$489.78
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.71 / $10.00 / $22.39	Facility	26	$8.71	$10.00	$22.39
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.30 / $107.15 / $676.08	Facility	TC	$26.30	$107.15	$676.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.22 / $34.67 / $107.15	Professional		$11.22	$34.67	$107.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $14.13 / $43.65	Professional	26	$7.08	$14.13	$43.65
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $33.88 / $79.43 / $281.84	Professional	50	$33.88	$79.43	$281.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $28.84 / $74.13	Professional	TC	$16.98	$28.84	$74.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $40.74 / $63.10	Professional		$20.42	$40.74	$63.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.01 / $12.30 / $13.80	Professional	26	$5.01	$12.30	$13.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $32.36 / $40.74	Professional	TC	$19.50	$32.36	$40.74
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 $25.12 / $44.67 / $87.10	Professional		$25.12	$44.67	$87.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $12.59 / $22.91	Professional	26	$6.92	$12.59	$22.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $32.36 / $66.07	Professional	TC	$17.38	$32.36	$66.07
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $56.23 / $165.96	Facility		$29.51	$56.23	$165.96
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $15.49 / $165.96	Facility	26	$8.91	$15.49	$165.96
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $20.89 / $38.02 / $165.96	Facility	TC	$20.89	$38.02	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $51.29 / $75.86	Professional		$26.92	$51.29	$75.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $13.80 / $19.50	Professional	26	$7.76	$13.80	$19.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $34.67 / $57.54	Professional	TC	$18.20	$34.67	$57.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $32.36 / $33.11	Professional		$14.45	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $53.70 / $58.88	Facility		$40.74	$53.70	$58.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $15.14 / $16.22	Facility	26	$12.59	$15.14	$16.22
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $28.18 / $38.02 / $43.65	Facility	TC	$28.18	$38.02	$43.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $13.80 / $17.38	Professional	26	$9.55	$13.80	$17.38
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $30.90 / $42.66	Professional	TC	$22.39	$30.90	$42.66
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $39.81 / $39.81	Facility		$39.81	$39.81	$39.81
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $10.47 / $10.47	Facility	26	$10.47	$10.47	$10.47
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $28.84 / $29.51	Facility	TC	$28.84	$28.84	$29.51
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $64.57 / $85.11	Professional		$39.81	$64.57	$85.11
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $16.98 / $22.91	Professional	26	$10.47	$16.98	$22.91
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $47.86 / $64.57	Professional	TC	$29.51	$47.86	$64.57
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 $39.81 / $58.88 / $81.28	Professional		$39.81	$58.88	$81.28
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $16.22 / $21.38	Professional	26	$10.96	$16.22	$21.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $42.66 / $61.66	Professional	TC	$29.51	$42.66	$61.66
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 $25.12 / $32.36 / $74.13	Professional		$25.12	$32.36	$74.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $8.91 / $20.89	Professional	26	$7.08	$8.91	$20.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $22.39 / $53.70	Professional	TC	$17.38	$22.39	$53.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $34.67 / $57.54	Professional		$30.20	$34.67	$57.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $8.91 / $14.79	Professional	26	$7.76	$8.91	$14.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $25.70 / $42.66	Professional	TC	$22.39	$25.70	$42.66