Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $263.03 / $575.44	Facility		$44.67	$263.03	$575.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $12.30 / $75.86	Facility	26	$9.55	$12.30	$75.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $34.67 / $223.87 / $645.65	Facility	TC	$34.67	$223.87	$645.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.96 / $43.65 / $131.83	Professional		$10.96	$43.65	$131.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $14.79 / $50.12	Professional	26	$7.76	$14.79	$50.12
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $37.15 / $102.33 / $213.80	Professional	50	$37.15	$102.33	$213.80
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $29.51 / $29.51 / $29.51	Professional	52	$29.51	$29.51	$29.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $40.74 / $97.72	Professional	TC	$22.91	$40.74	$97.72
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $47.86 / $72.44	Professional		$26.30	$47.86	$72.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $13.49 / $15.85	Professional	26	$6.31	$13.49	$15.85
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $47.86 / $61.66	Professional	TC	$29.51	$47.86	$61.66
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $309.03 / $371.54	Facility		$147.91	$309.03	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $53.70 / $109.65	Professional		$30.20	$53.70	$109.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $13.49 / $24.55	Professional	26	$7.41	$13.49	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $40.74 / $87.10	Professional	TC	$20.89	$40.74	$87.10
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $67.61 / $165.96	Facility		$36.31	$67.61	$165.96
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $16.60 / $165.96	Facility	26	$9.33	$16.60	$165.96
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $26.30 / $48.98 / $165.96	Facility	TC	$26.30	$48.98	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $61.66 / $95.50	Professional		$32.36	$61.66	$95.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $15.14 / $21.38	Professional	26	$8.13	$15.14	$21.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $45.71 / $74.13	Professional	TC	$23.99	$45.71	$74.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $18.62 / $32.36 / $33.11	Professional		$18.62	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $66.07 / $74.13	Facility		$46.77	$66.07	$74.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $16.60 / $16.60	Facility	26	$13.80	$16.60	$16.60
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $34.67 / $48.98 / $57.54	Facility	TC	$34.67	$48.98	$57.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.79 / $18.62	Professional	26	$10.00	$14.79	$18.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $40.74 / $56.23	Professional	TC	$28.84	$40.74	$56.23
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $50.12 / $50.12	Facility		$50.12	$50.12	$50.12
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $11.22 / $11.22 / $11.48	Facility	26	$11.22	$11.22	$11.48
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $38.90 / $38.90 / $38.90	Facility	TC	$38.90	$38.90	$38.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $81.28 / $104.71	Professional		$50.12	$81.28	$104.71
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $18.62 / $25.12	Professional	26	$11.48	$18.62	$25.12
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $63.10 / $83.18	Professional	TC	$38.90	$63.10	$83.18
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 $51.29 / $74.13 / $102.33	Professional		$51.29	$74.13	$102.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $17.78 / $23.44	Professional	26	$11.75	$17.78	$23.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $56.23 / $79.43	Professional	TC	$38.90	$56.23	$79.43
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 $28.84 / $38.90 / $91.20	Professional		$28.84	$38.90	$91.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $9.33 / $21.88	Professional	26	$7.59	$9.33	$21.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $28.84 / $69.18	Professional	TC	$20.89	$28.84	$69.18
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $44.67 / $74.13	Professional		$38.90	$44.67	$74.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $9.77 / $16.22	Professional	26	$8.51	$9.77	$16.22
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $34.67 / $57.54	Professional	TC	$30.20	$34.67	$57.54