Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $165.96 / $758.58	Facility		$87.10	$165.96	$758.58
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.77 / $74.13 / $95.50	Facility	26	$46.77	$74.13	$95.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $109.65 / $457.09	Professional		$45.71	$109.65	$457.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $58.88 / $194.98	Professional	26	$33.11	$58.88	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $40.74 / $165.96	Professional	TC	$25.70	$40.74	$165.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $40.74 / $69.18	Professional		$24.55	$40.74	$69.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $66.07 / $69.18	Professional	26	$66.07	$66.07	$69.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $23.99 / $23.99	Professional	TC	$23.99	$23.99	$23.99
Cigna Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $63.10 / $63.10	Facility		$63.10	$63.10	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $154.88 / $302.00	Professional		$81.28	$154.88	$302.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $75.86 / $125.89	Professional	26	$42.66	$75.86	$125.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $66.07 / $199.53	Professional	TC	$35.48	$66.07	$199.53
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $158.49 / $316.23	Facility		$61.66	$158.49	$316.23
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $81.28 / $151.36	Facility	26	$40.74	$81.28	$151.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $138.04 / $288.40	Professional		$60.26	$138.04	$288.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $69.18 / $109.65	Professional	26	$33.88	$69.18	$109.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $67.61 / $181.97	Professional	TC	$28.18	$67.61	$181.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $5.13 / $32.36 / $38.02	Professional		$5.13	$32.36	$38.02
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $125.89 / $354.81	Facility		$104.71	$125.89	$354.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $70.79 / $141.25	Facility	26	$60.26	$70.79	$141.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $81.28 / $144.54	Professional	26	$48.98	$81.28	$144.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $66.07 / $213.80	Professional	TC	$40.74	$66.07	$213.80
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $85.11 / $89.13	Facility		$85.11	$85.11	$89.13
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $48.98 / $50.12	Facility	26	$48.98	$48.98	$50.12
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $138.04 / $186.21	Professional		$89.13	$138.04	$186.21
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $77.62 / $104.71	Professional	26	$50.12	$77.62	$104.71
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $58.88 / $81.28	Professional	TC	$38.02	$58.88	$81.28
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $446.68 / $851.14	Facility		$302.00	$446.68	$851.14
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $269.15 / $269.15 / $269.15	Facility	26	$269.15	$269.15	$269.15
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $123.03 / $169.82	Professional		$85.11	$123.03	$169.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $70.79 / $95.50	Professional	26	$48.98	$70.79	$95.50
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $53.70 / $74.13	Professional	TC	$37.15	$53.70	$74.13
United Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $501.19 / $1,862.09	Facility		$371.54	$501.19	$1,862.09
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $134.90 / $281.84	Professional		$70.79	$134.90	$281.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $77.62 / $117.49	Professional	26	$39.81	$77.62	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $57.54 / $173.78	Professional	TC	$29.51	$57.54	$173.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $75.86 / $128.82	Professional		$67.61	$75.86	$128.82
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $39.81 / $70.79	Professional	26	$37.15	$39.81	$70.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $36.31 / $58.88	Professional	TC	$30.90	$36.31	$58.88