Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $177.83 / $912.01 / $1,348.96	Facility		$177.83	$912.01	$1,348.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $34.67 / $56.23	Facility	26	$25.12	$34.67	$56.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $114.82 / $309.03	Professional		$77.62	$114.82	$309.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $21.38 / $81.28	Professional	26	$12.88	$21.38	$81.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $87.10 / $208.93	Professional	TC	$60.26	$87.10	$208.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Professional		$204.17	$204.17	$204.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $26.30 / $28.18	Professional	26	$26.30	$26.30	$28.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $478.63 / $870.96 / $1,023.29	Facility		$478.63	$870.96	$1,023.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $151.36 / $316.23	Professional		$81.28	$151.36	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $25.12 / $45.71	Professional	26	$13.80	$25.12	$45.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $125.89 / $269.15	Professional	TC	$64.57	$125.89	$269.15
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $177.83 / $630.96	Facility		$100.00	$177.83	$630.96
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $18.20 / $30.20 / $630.96	Facility	26	$18.20	$30.20	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $158.49 / $269.15	Professional		$83.18	$158.49	$269.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $28.18 / $38.90	Professional	26	$15.49	$28.18	$38.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $131.83 / $234.42	Professional	TC	$67.61	$131.83	$234.42
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $57.54	Professional		$32.36	$33.11	$57.54
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $181.97 / $208.93	Facility		$128.82	$181.97	$208.93
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $30.20 / $31.62	Facility	26	$25.12	$30.20	$31.62
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $27.54 / $33.88	Professional	26	$18.62	$27.54	$33.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $120.23 / $177.83	Professional	TC	$83.18	$120.23	$177.83
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $144.54	Facility		$141.25	$141.25	$144.54
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $20.42 / $20.42 / $20.89	Facility	26	$20.42	$20.42	$20.89
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $229.09 / $295.12	Professional		$141.25	$229.09	$295.12
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $33.88 / $45.71	Professional	26	$20.89	$33.88	$45.71
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $194.98 / $257.04	Professional	TC	$120.23	$194.98	$257.04
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $478.63 / $676.08 / $1,318.26	Facility		$478.63	$676.08	$1,318.26
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	26	$446.68	$446.68	$446.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $208.93 / $295.12	Professional		$147.91	$208.93	$295.12
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $32.36 / $43.65	Professional	26	$21.38	$32.36	$43.65
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $177.83 / $251.19	Professional	TC	$123.03	$177.83	$251.19
United Facility/Professional Facility Modifier Low / Median / High Price $676.08 / $912.01 / $1,621.81	Facility		$676.08	$912.01	$1,621.81
United Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $107.15 / $257.04	Professional		$79.43	$107.15	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $17.78 / $39.81	Professional	26	$14.13	$17.78	$39.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $89.13 / $218.78	Professional	TC	$64.57	$89.13	$218.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $125.89 / $208.93	Professional		$109.65	$125.89	$208.93
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $18.20 / $30.20	Professional	26	$15.85	$18.20	$30.20
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $109.65 / $177.83	Professional	TC	$95.50	$109.65	$177.83