Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $14.79 / $31.62	Facility	26	$12.30	$14.79	$31.62
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $43.65 / $147.91 / $724.44	Facility	TC	$43.65	$147.91	$724.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $57.54 / $199.53	Professional		$21.38	$57.54	$199.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $21.38 / $64.57	Professional	26	$10.00	$21.38	$64.57
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $46.77 / $114.82 / $346.74	Professional	50	$46.77	$114.82	$346.74
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $43.65 / $43.65 / $43.65	Professional	52	$43.65	$43.65	$43.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $53.70 / $134.90	Professional	TC	$28.18	$53.70	$134.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $85.11 / $112.20	Professional		$43.65	$85.11	$112.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $18.62 / $22.39	Professional	26	$8.32	$18.62	$22.39
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $61.66 / $70.79 / $169.82	Professional	50	$61.66	$70.79	$169.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $63.10 / $87.10	Professional	TC	$40.74	$63.10	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $70.79 / $141.25	Professional		$38.02	$70.79	$141.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $17.38 / $33.11	Professional	26	$9.77	$17.38	$33.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $52.48 / $112.20	Professional	TC	$26.92	$52.48	$112.20
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $21.38 / $165.96	Facility	26	$12.02	$21.38	$165.96
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $33.11 / $61.66 / $165.96	Facility	TC	$33.11	$61.66	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $79.43 / $123.03	Professional		$42.66	$79.43	$123.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $20.42 / $28.18	Professional	26	$10.72	$20.42	$28.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $57.54 / $97.72	Professional	TC	$30.20	$57.54	$97.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $32.36 / $33.11	Professional		$24.55	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $18.20 / $21.38 / $21.88	Facility	26	$18.20	$21.38	$21.88
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $43.65 / $61.66 / $72.44	Facility	TC	$43.65	$61.66	$72.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $19.50 / $23.44	Professional	26	$13.80	$19.50	$23.44
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $51.29 / $72.44	Professional	TC	$38.02	$51.29	$72.44
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $14.45 / $15.14	Facility	26	$14.45	$14.45	$15.14
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $47.86 / $47.86 / $50.12	Facility	TC	$47.86	$47.86	$50.12
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $104.71 / $138.04	Professional		$64.57	$104.71	$138.04
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $24.55 / $33.11	Professional	26	$15.14	$24.55	$33.11
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $79.43 / $109.65	Professional	TC	$50.12	$79.43	$109.65
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 $63.10 / $93.33 / $131.83	Professional		$63.10	$93.33	$131.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $22.91 / $30.90	Professional	26	$15.49	$22.91	$30.90
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $70.79 / $102.33	Professional	TC	$48.98	$70.79	$102.33
United Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $48.98 / $114.82	Professional		$36.31	$48.98	$114.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $12.30 / $28.18	Professional	26	$9.77	$12.30	$28.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $36.31 / $87.10	Professional	TC	$26.92	$36.31	$87.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $58.88 / $97.72	Professional		$51.29	$58.88	$97.72
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $12.88 / $21.38	Professional	26	$11.22	$12.88	$21.38
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $46.77 / $75.86	Professional	TC	$40.74	$46.77	$75.86