Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $177.83 / $524.81	Facility		$48.98	$177.83	$524.81
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $15.85 / $30.90	Facility	26	$12.30	$15.85	$30.90
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $37.15 / $74.13 / $426.58	Facility	TC	$37.15	$74.13	$426.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $52.48 / $162.18	Professional		$34.67	$52.48	$162.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $14.79 / $43.65	Professional	26	$8.91	$14.79	$43.65
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.02 / $50.12 / $194.98	Professional	50	$38.02	$50.12	$194.98
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.78 / $17.78 / $17.78	Professional	52	$17.78	$17.78	$17.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $32.36 / $79.43	Professional	TC	$23.99	$32.36	$79.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $67.61 / $87.10	Professional		$30.20	$67.61	$87.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $17.78 / $20.89	Professional	26	$8.51	$17.78	$20.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $42.66 / $72.44	Professional	TC	$23.44	$42.66	$72.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $389.05 / $501.19	Facility		$234.42	$389.05	$501.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $64.57 / $123.03	Professional		$34.67	$64.57	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $17.38 / $31.62	Professional	26	$9.55	$17.38	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $46.77 / $95.50	Professional	TC	$25.70	$46.77	$95.50
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $77.62 / $288.40	Facility		$45.71	$77.62	$288.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $20.89 / $288.40	Facility	26	$13.18	$20.89	$288.40
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $33.11 / $53.70 / $288.40	Facility	TC	$33.11	$53.70	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $72.44 / $107.15	Professional		$38.90	$72.44	$107.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $19.50 / $27.54	Professional	26	$10.96	$19.50	$27.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $50.12 / $81.28	Professional	TC	$28.18	$50.12	$81.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $32.36 / $33.11	Professional		$20.42	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $81.28 / $83.18	Facility		$57.54	$81.28	$83.18
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.78 / $20.89 / $21.88	Facility	26	$17.78	$20.89	$21.88
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $44.67 / $56.23 / $61.66	Facility	TC	$44.67	$56.23	$61.66
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $17.78 / $22.91	Professional	26	$13.18	$17.78	$22.91
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $50.12 / $60.26	Professional	TC	$36.31	$50.12	$60.26
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $56.23 / $56.23	Facility		$56.23	$56.23	$56.23
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $14.45 / $14.45	Facility	26	$14.45	$14.45	$14.45
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $41.69 / $41.69 / $41.69	Facility	TC	$41.69	$41.69	$41.69
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $91.20 / $120.23	Professional		$56.23	$91.20	$120.23
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $23.44 / $32.36	Professional	26	$14.45	$23.44	$32.36
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $67.61 / $91.20	Professional	TC	$41.69	$67.61	$91.20
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $223.87 / $302.00 / $602.56	Facility		$223.87	$302.00	$602.56
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	TC	$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $83.18 / $114.82	Professional		$56.23	$83.18	$114.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $22.91 / $30.20	Professional	26	$15.14	$22.91	$30.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $60.26 / $85.11	Professional	TC	$41.69	$60.26	$85.11
United Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $398.11 / $707.95	Facility		$295.12	$398.11	$707.95
United Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $45.71 / $104.71	Professional		$36.31	$45.71	$104.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $12.59 / $27.54	Professional	26	$10.00	$12.59	$27.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $31.62 / $75.86	Professional	TC	$26.30	$31.62	$75.86
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $50.12 / $83.18	Professional		$43.65	$50.12	$83.18
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $12.59 / $20.89	Professional	26	$10.96	$12.59	$20.89
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $37.15 / $61.66	Professional	TC	$32.36	$37.15	$61.66