Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $354.81 / $13,489.63	Facility		$181.97	$354.81	$13,489.63
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $151.36 / $199.53	Facility	26	$91.20	$151.36	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $181.97 / $371.54	Professional		$109.65	$181.97	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $81.28 / $234.42	Professional	26	$50.12	$81.28	$234.42
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $134.90 / $134.90 / $134.90	Professional	52	$134.90	$134.90	$134.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $93.33 / $234.42	Professional	TC	$58.88	$93.33	$234.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $151.36 / $162.18	Professional	26	$67.61	$151.36	$162.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $5,128.61 / $10,964.78 / $13,182.57	Facility		$5,128.61	$10,964.78	$13,182.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $288.40 / $512.86	Professional		$147.91	$288.40	$512.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $112.20 / $229.09	Professional	26	$57.54	$112.20	$229.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $158.49 / $389.05	Professional	TC	$69.18	$158.49	$389.05
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $223.87 / $338.84 / $7,413.10	Facility		$223.87	$338.84	$7,413.10
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $141.25 / $7,413.10	Facility	26	$70.79	$141.25	$7,413.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $316.23 / $416.87	Professional		$181.97	$316.23	$416.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $128.82 / $199.53	Professional	26	$67.61	$128.82	$199.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $173.78 / $269.15	Professional	TC	$102.33	$173.78	$269.15
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 $245.47 / $295.12 / $512.86	Facility		$245.47	$295.12	$512.86
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $151.36 / $165.96	Facility	26	$91.20	$151.36	$165.96
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $102.33 / $165.96	Professional	26	$75.86	$102.33	$165.96
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $177.83 / $309.03	Professional	TC	$102.33	$177.83	$309.03
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Facility		$204.17	$204.17	$204.17
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $112.20	Facility	26	$109.65	$109.65	$112.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $338.84 / $446.68	Professional		$204.17	$338.84	$446.68
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $181.97 / $245.47	Professional	26	$112.20	$181.97	$245.47
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $158.49 / $229.09	Professional	TC	$95.50	$158.49	$229.09
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $5,888.44 / $8,912.51 / $17,378.01	Facility		$5,888.44	$8,912.51	$17,378.01
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $5,495.41 / $5,495.41 / $5,495.41	Facility	26	$5,495.41	$5,495.41	$5,495.41
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $316.23 / $426.58	Professional		$208.93	$316.23	$426.58
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $165.96 / $229.09	Professional	26	$112.20	$165.96	$229.09
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $147.91 / $218.78	Professional	TC	$97.72	$147.91	$218.78
United Facility/Professional Facility Modifier Low / Median / High Price $8,912.51 / $12,022.64 / $21,379.62	Facility		$8,912.51	$12,022.64	$21,379.62
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $213.80 / $478.63	Professional		$158.49	$213.80	$478.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $89.13 / $208.93	Professional	26	$56.23	$89.13	$208.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $120.23 / $269.15	Professional	TC	$74.13	$120.23	$269.15
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $173.78 / $288.40	Professional		$151.36	$173.78	$288.40
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $93.33 / $151.36	Professional	26	$79.43	$93.33	$151.36
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $83.18 / $138.04	Professional	TC	$72.44	$83.18	$138.04