Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $186.21 / $676.08 / $17,782.79	Facility		$186.21	$676.08	$17,782.79
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $79.43 / $102.33	Facility	26	$50.12	$79.43	$102.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $257.04 / $758.58	Professional		$151.36	$257.04	$758.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $57.54 / $181.97	Professional	26	$37.15	$57.54	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $158.49 / $354.81	Professional	TC	$97.72	$158.49	$354.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $309.03 / $354.81	Professional		$169.82	$309.03	$354.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $70.79 / $74.13	Professional	26	$70.79	$70.79	$74.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $199.53 / $199.53	Professional	TC	$199.53	$199.53	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $371.54 / $588.84	Professional		$144.54	$371.54	$588.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $79.43 / $117.49	Professional	26	$51.29	$79.43	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $295.12 / $467.74	Professional	TC	$93.33	$295.12	$467.74
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $269.15 / $501.19	Facility		$151.36	$269.15	$501.19
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $81.28 / $102.33	Facility	26	$48.98	$81.28	$102.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $288.40 / $501.19	Professional		$151.36	$288.40	$501.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $83.18 / $102.33	Professional	26	$48.98	$83.18	$102.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $199.53 / $416.87	Professional	TC	$100.00	$199.53	$416.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $64.57	Professional		$32.36	$32.36	$64.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $309.03 / $380.19	Facility		$181.97	$309.03	$380.19
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $75.86 / $79.43	Facility	26	$64.57	$75.86	$79.43
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $66.07 / $87.10	Professional	26	$52.48	$66.07	$87.10
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $131.83 / $229.09	Professional	TC	$100.00	$131.83	$229.09
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $257.04 / $269.15	Facility		$257.04	$257.04	$269.15
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $52.48 / $53.70	Facility	26	$52.48	$52.48	$53.70
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $416.87 / $501.19	Professional		$257.04	$416.87	$501.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $89.13 / $114.82	Professional	26	$53.70	$89.13	$114.82
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $316.23 / $380.19	Professional	TC	$204.17	$316.23	$380.19
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $354.81 / $354.81 / $446.68	Facility		$354.81	$354.81	$446.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $354.81 / $489.78	Professional		$275.42	$354.81	$489.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $75.86 / $100.00	Professional	26	$53.70	$75.86	$100.00
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $281.84 / $398.11	Professional	TC	$199.53	$281.84	$398.11
United Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $660.69 / $6,165.95	Facility		$190.55	$660.69	$6,165.95
United Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $251.19 / $562.34	Professional		$154.88	$251.19	$562.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $67.61 / $112.20	Professional	26	$40.74	$67.61	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $190.55 / $426.58	Professional	TC	$112.20	$190.55	$426.58
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $218.78 / $309.03	Professional		$162.18	$218.78	$309.03
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $53.70 / $75.86	Professional	26	$39.81	$53.70	$75.86
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $165.96 / $229.09	Professional	TC	$123.03	$165.96	$229.09