Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $218.78 / $562.34	Facility		$51.29	$218.78	$562.34
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $12.30 / $26.30	Facility	26	$10.23	$12.30	$26.30
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $38.90 / $169.82 / $446.68	Facility	TC	$38.90	$169.82	$446.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.23 / $50.12 / $169.82	Professional		$10.23	$50.12	$169.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $17.38 / $54.95	Professional	26	$8.51	$17.38	$54.95
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.38 / $79.43 / $229.09	Professional	50	$17.38	$79.43	$229.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $44.67 / $125.89	Professional	TC	$25.12	$44.67	$125.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $69.18 / $89.13	Professional		$28.84	$69.18	$89.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $15.14 / $17.78	Professional	26	$6.61	$15.14	$17.78
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $41.69 / $41.69 / $41.69	Professional	50	$41.69	$41.69	$41.69
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $54.95 / $77.62	Professional	TC	$30.90	$54.95	$77.62
Cigna Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $309.03 / $371.54	Facility		$181.97	$309.03	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $60.26 / $123.03	Professional		$33.11	$60.26	$123.03
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 $23.99 / $46.77 / $97.72	Professional	TC	$23.99	$46.77	$97.72
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $75.86 / $165.96	Facility		$38.02	$75.86	$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 $28.84 / $54.95 / $165.96	Facility	TC	$28.84	$54.95	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $69.18 / $107.15	Professional		$36.31	$69.18	$107.15
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 $26.92 / $52.48 / $85.11	Professional	TC	$26.92	$52.48	$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 Low / Median / High Price $52.48 / $74.13 / $83.18	Facility		$52.48	$74.13	$83.18
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 $38.90 / $56.23 / $64.57	Facility	TC	$38.90	$56.23	$64.57
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $36.31 / $36.31	Professional		$36.31	$36.31	$36.31
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $16.98 / $20.42	Professional	26	$11.22	$16.98	$20.42
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $46.77 / $67.61	Professional	TC	$34.67	$46.77	$67.61
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $54.95 / $56.23	Facility		$54.95	$54.95	$56.23
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 $42.66 / $42.66 / $43.65	Facility	TC	$42.66	$42.66	$43.65
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $91.20 / $117.49	Professional		$56.23	$91.20	$117.49
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 $43.65 / $70.79 / $93.33	Professional	TC	$43.65	$70.79	$93.33
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 $56.23 / $81.28 / $114.82	Professional		$56.23	$81.28	$114.82
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 $43.65 / $63.10 / $89.13	Professional	TC	$43.65	$63.10	$89.13
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 $32.36 / $42.66 / $102.33	Professional		$32.36	$42.66	$102.33
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 $23.99 / $32.36 / $77.62	Professional	TC	$23.99	$32.36	$77.62
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $51.29 / $83.18	Professional		$44.67	$51.29	$83.18
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $10.96 / $18.20	Professional	26	$9.55	$10.96	$18.20
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $39.81 / $66.07	Professional	TC	$34.67	$39.81	$66.07