Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $141.25 / $691.83	Facility		$61.66	$141.25	$691.83
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.14 / $25.70 / $48.98	Facility	26	$15.14	$25.70	$48.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $40.74 / $107.15	Professional		$28.84	$40.74	$107.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $18.62 / $70.79	Professional	26	$10.96	$18.62	$70.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $25.12 / $60.26	Professional	TC	$16.98	$25.12	$60.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $70.79 / $70.79	Professional		$70.79	$70.79	$70.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $22.91 / $26.92	Professional	26	$13.49	$22.91	$26.92
Cigna Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $58.88 / $58.88	Facility		$58.88	$58.88	$58.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.31 / $15.49 / $21.88	Facility	26	$3.31	$15.49	$21.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $58.88 / $117.49	Professional		$33.88	$58.88	$117.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $22.91 / $40.74	Professional	26	$14.13	$22.91	$40.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $38.02 / $77.62	Professional	TC	$19.50	$38.02	$77.62
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $61.66 / $102.33	Facility		$38.90	$61.66	$102.33
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $25.70 / $35.48	Facility	26	$16.60	$25.70	$35.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $63.10 / $102.33	Professional		$38.90	$63.10	$102.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $26.30 / $36.31	Professional	26	$16.22	$26.30	$36.31
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $35.48 / $66.07	Professional	TC	$21.88	$35.48	$66.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $32.36 / $33.11	Professional		$25.12	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $69.18 / $77.62	Facility		$51.29	$69.18	$77.62
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $26.30 / $28.84	Facility	26	$21.88	$26.30	$28.84
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Professional		$109.65	$109.65	$109.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $25.70 / $33.11	Professional	26	$17.38	$25.70	$33.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $34.67 / $50.12	Professional	TC	$22.91	$34.67	$50.12
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $52.48 / $52.48	Facility		$52.48	$52.48	$52.48
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $18.20 / $18.20 / $18.62	Facility	26	$18.20	$18.20	$18.62
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $85.11 / $112.20	Professional		$52.48	$85.11	$112.20
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $30.90 / $39.81	Professional	26	$18.62	$30.90	$39.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $54.95 / $74.13	Professional	TC	$33.88	$54.95	$74.13
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $35.48 / $35.48	Facility		$35.48	$35.48	$35.48
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $74.13 / $107.15	Professional		$53.70	$74.13	$107.15
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $27.54 / $37.15	Professional	26	$18.62	$27.54	$37.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $47.86 / $70.79	Professional	TC	$35.48	$47.86	$70.79
United Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $39.81 / $89.13	Professional		$32.36	$39.81	$89.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $15.85 / $35.48	Professional	26	$14.13	$15.85	$35.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $24.55 / $54.95	Professional	TC	$18.62	$24.55	$54.95
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $47.86 / $79.43	Professional		$41.69	$47.86	$79.43
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $15.85 / $26.30	Professional	26	$13.80	$15.85	$26.30
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $32.36 / $53.70	Professional	TC	$28.18	$32.36	$53.70