Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $190.55 / $457.09	Facility		$38.02	$190.55	$457.09
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.71 / $10.72 / $21.38	Facility	26	$8.71	$10.72	$21.38
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $154.88 / $524.81	Facility	TC	$28.84	$154.88	$524.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.96 / $37.15 / $114.82	Professional		$10.96	$37.15	$114.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $14.45 / $44.67	Professional	26	$7.08	$14.45	$44.67
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $33.88 / $77.62 / $257.04	Professional	50	$33.88	$77.62	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $31.62 / $75.86	Professional	TC	$17.78	$31.62	$75.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $52.48 / $64.57	Professional		$25.12	$52.48	$64.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $12.88 / $14.13	Professional	26	$7.24	$12.88	$14.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $39.81 / $54.95	Professional	TC	$21.38	$39.81	$54.95
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 $26.30 / $47.86 / $95.50	Professional		$26.30	$47.86	$95.50
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 $18.20 / $34.67 / $74.13	Professional	TC	$18.20	$34.67	$74.13
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $30.90 / $58.88 / $165.96	Facility		$30.90	$58.88	$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 $21.38 / $40.74 / $165.96	Facility	TC	$21.38	$40.74	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $53.70 / $81.28	Professional		$28.18	$53.70	$81.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $14.45 / $19.95	Professional	26	$7.76	$14.45	$19.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $38.02 / $63.10	Professional	TC	$19.95	$38.02	$63.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $32.36 / $33.11	Professional		$15.85	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $57.54 / $63.10	Facility		$40.74	$57.54	$63.10
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 $32.36 / $42.66 / $47.86	Facility	TC	$32.36	$42.66	$47.86
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $14.13 / $17.78	Professional	26	$9.55	$14.13	$17.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $33.11 / $42.66	Professional	TC	$23.99	$33.11	$42.66
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $42.66 / $43.65	Facility		$42.66	$42.66	$43.65
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 $32.36 / $32.36 / $33.11	Facility	TC	$32.36	$32.36	$33.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $69.18 / $93.33	Professional		$43.65	$69.18	$93.33
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 $33.11 / $52.48 / $69.18	Professional	TC	$33.11	$52.48	$69.18
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 $43.65 / $63.10 / $89.13	Professional		$43.65	$63.10	$89.13
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 $33.11 / $47.86 / $67.61	Professional	TC	$33.11	$47.86	$67.61
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 $26.30 / $33.88 / $79.43	Professional		$26.30	$33.88	$79.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $9.12 / $19.95	Professional	26	$7.24	$9.12	$19.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $24.55 / $58.88	Professional	TC	$18.20	$24.55	$58.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $37.15 / $61.66	Professional		$32.36	$37.15	$61.66
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 $25.12 / $28.84 / $46.77	Professional	TC	$25.12	$28.84	$46.77