Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $467.74 / $1,819.70	Facility		$67.61	$467.74	$1,819.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $46.77 / $89.13	Facility	26	$33.88	$46.77	$89.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $114.82 / $436.52	Professional		$51.29	$114.82	$436.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $44.67 / $169.82	Professional	26	$28.18	$44.67	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $35.48 / $186.21	Professional	TC	$21.38	$35.48	$186.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $89.13 / $123.03	Professional		$51.29	$89.13	$123.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $53.70 / $61.66	Professional	26	$30.90	$53.70	$61.66
Cigna Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Facility		$93.33	$93.33	$93.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.41 / $34.67 / $48.98	Facility	26	$7.41	$34.67	$48.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $123.03 / $295.12	Professional		$60.26	$123.03	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $51.29 / $89.13	Professional	26	$32.36	$51.29	$89.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $60.26 / $229.09	Professional	TC	$28.84	$60.26	$229.09
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $147.91 / $316.23	Facility		$91.20	$147.91	$316.23
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $56.23 / $77.62	Facility	26	$36.31	$56.23	$77.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $144.54 / $281.84	Professional		$89.13	$144.54	$281.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $57.54 / $77.62	Professional	26	$36.31	$57.54	$77.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $70.79 / $239.88	Professional	TC	$41.69	$70.79	$239.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $38.02	Professional		$32.36	$32.36	$38.02
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $114.82 / $257.04	Facility		$95.50	$114.82	$257.04
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $58.88 / $61.66	Facility	26	$48.98	$58.88	$61.66
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $263.03 / $263.03	Professional		$263.03	$263.03	$263.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $56.23 / $66.07	Professional	26	$38.02	$56.23	$66.07
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $56.23 / $281.84	Professional	TC	$36.31	$56.23	$281.84
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $77.62 / $79.43	Facility		$77.62	$77.62	$79.43
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $40.74 / $40.74	Facility	26	$40.74	$40.74	$40.74
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $131.83 / $177.83	Professional		$79.43	$131.83	$177.83
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $66.07 / $89.13	Professional	26	$40.74	$66.07	$89.13
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $64.57 / $97.72	Professional	TC	$38.90	$64.57	$97.72
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $38.02 / $38.02	Facility		$38.02	$38.02	$38.02
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $117.49 / $165.96	Professional		$79.43	$117.49	$165.96
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $61.66 / $83.18	Professional	26	$41.69	$61.66	$83.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $57.54 / $79.43	Professional	TC	$38.02	$57.54	$79.43
United Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $85.11 / $208.93	Professional		$58.88	$85.11	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $34.67 / $77.62	Professional	26	$31.62	$34.67	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $40.74 / $158.49	Professional	TC	$25.70	$40.74	$158.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $75.86 / $125.89	Professional		$66.07	$75.86	$125.89
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $36.31 / $60.26	Professional	26	$31.62	$36.31	$60.26
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $39.81 / $64.57	Professional	TC	$34.67	$39.81	$64.57