Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $281.84 / $575.44	Facility		$100.00	$281.84	$575.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $42.66 / $91.20	Facility	26	$37.15	$42.66	$91.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $104.71 / $416.87	Professional		$50.12	$104.71	$416.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $53.70 / $173.78	Professional	26	$29.51	$53.70	$173.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $74.13 / $194.98 / $676.08	Professional	50	$74.13	$194.98	$676.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $63.10 / $269.15	Professional	TC	$43.65	$63.10	$269.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $162.18 / $194.98	Professional		$61.66	$162.18	$194.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $52.48 / $63.10	Professional	26	$23.99	$52.48	$63.10
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $89.13 / $245.47 / $346.74	Professional	50	$89.13	$245.47	$346.74
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $48.98 / $48.98	Professional	TC	$48.98	$48.98	$48.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $309.03 / $398.11	Facility		$131.83	$309.03	$398.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $52.48	Facility	26	$7.94	$37.15	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $147.91 / $269.15	Professional		$87.10	$147.91	$269.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $54.95 / $95.50	Professional	26	$33.88	$54.95	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $91.20 / $165.96	Professional	TC	$52.48	$91.20	$165.96
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $162.18 / $275.42	Facility		$87.10	$162.18	$275.42
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $63.10 / $234.42	Facility	26	$37.15	$63.10	$234.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $162.18 / $234.42	Professional		$97.72	$162.18	$234.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $61.66 / $83.18	Professional	26	$36.31	$61.66	$83.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $102.33 / $151.36	Professional	TC	$60.26	$102.33	$151.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $56.23	Professional		$32.36	$33.11	$56.23
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $165.96 / $173.78	Facility		$125.89	$165.96	$173.78
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $63.10 / $64.57	Facility	26	$52.48	$63.10	$64.57
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $52.48 / $64.57	Professional	26	$38.90	$52.48	$64.57
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $93.33 / $107.15	Professional	TC	$64.57	$93.33	$107.15
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $114.82 / $117.49	Facility		$114.82	$114.82	$117.49
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $43.65 / $43.65	Facility	26	$43.65	$43.65	$43.65
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $190.55 / $245.47	Professional		$117.49	$190.55	$245.47
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $72.44 / $97.72	Professional	26	$43.65	$72.44	$97.72
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $120.23 / $158.49	Professional	TC	$72.44	$120.23	$158.49
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $177.83 / $257.04 / $489.78	Facility		$177.83	$257.04	$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 Professional Modifier Low / Median / High Price $117.49 / $169.82 / $234.42	Professional		$117.49	$169.82	$234.42
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $66.07 / $89.13	Professional	26	$44.67	$66.07	$89.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $104.71 / $144.54	Professional	TC	$72.44	$104.71	$144.54
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 $85.11 / $97.72 / $213.80	Professional		$85.11	$97.72	$213.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $36.31 / $83.18	Professional	26	$33.11	$36.31	$83.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $58.88 / $131.83	Professional	TC	$52.48	$58.88	$131.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $100.00 / $165.96	Professional		$87.10	$100.00	$165.96
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $36.31 / $60.26	Professional	26	$31.62	$36.31	$60.26
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $63.10 / $104.71	Professional	TC	$54.95	$63.10	$104.71