Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.59 / $8.91 / $16.98	Facility	26	$7.59	$8.91	$16.98
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $38.02 / $173.78 / $457.09	Facility	TC	$38.02	$173.78	$457.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $45.71 / $141.25	Professional		$14.45	$45.71	$141.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $11.48 / $37.15	Professional	26	$6.03	$11.48	$37.15
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $31.62 / $141.25 / $288.40	Professional	50	$31.62	$141.25	$288.40
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.47 / $60.26 / $158.49	Professional	52	$10.47	$60.26	$158.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $41.69 / $91.20	Professional	TC	$22.91	$41.69	$91.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $64.57 / $81.28	Professional		$28.18	$64.57	$81.28
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.01 / $11.22 / $12.30	Professional	26	$5.01	$11.22	$12.30
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $54.95 / $69.18	Professional	TC	$30.20	$54.95	$69.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $56.23 / $117.49	Professional		$28.18	$56.23	$117.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.89 / $10.72 / $19.95	Professional	26	$5.89	$10.72	$19.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $45.71 / $97.72	Professional	TC	$22.39	$45.71	$97.72
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $7.59 / $13.18 / $165.96	Facility	26	$7.59	$13.18	$165.96
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $25.70 / $53.70 / $165.96	Facility	TC	$25.70	$53.70	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $63.10 / $100.00	Professional		$31.62	$63.10	$100.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $12.02 / $16.98	Professional	26	$6.46	$12.02	$16.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $50.12 / $85.11	Professional	TC	$25.12	$50.12	$85.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $32.36 / $33.11	Professional		$21.38	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $13.18 / $13.49	Facility	26	$10.96	$13.18	$13.49
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $37.15 / $53.70 / $63.10	Facility	TC	$37.15	$53.70	$63.10
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $11.48 / $14.45	Professional	26	$7.59	$11.48	$14.45
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $42.66 / $60.26	Professional	TC	$30.20	$42.66	$60.26
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $9.12 / $9.12	Facility	26	$9.12	$9.12	$9.12
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $41.69 / $41.69 / $43.65	Facility	TC	$41.69	$41.69	$43.65
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $85.11 / $112.20	Professional		$52.48	$85.11	$112.20
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $14.79 / $19.95	Professional	26	$9.12	$14.79	$19.95
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $69.18 / $93.33	Professional	TC	$43.65	$69.18	$93.33
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 $51.29 / $75.86 / $107.15	Professional		$51.29	$75.86	$107.15
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $14.13 / $18.62	Professional	26	$9.33	$14.13	$18.62
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $61.66 / $89.13	Professional	TC	$42.66	$61.66	$89.13
United Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $38.02 / $93.33	Professional		$27.54	$38.02	$93.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $7.41 / $17.38	Professional	26	$5.75	$7.41	$17.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $31.62 / $75.86	Professional	TC	$21.88	$31.62	$75.86
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $46.77 / $77.62	Professional		$40.74	$46.77	$77.62
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $7.76 / $12.88	Professional	26	$6.76	$7.76	$12.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $39.81 / $64.57	Professional	TC	$34.67	$39.81	$64.57