Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $354.81 / $1,096.48 / $2,754.23	Facility		$354.81	$1,096.48	$2,754.23
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $100.00 / $169.82	Facility	26	$93.33	$100.00	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $302.00 / $933.25	Professional		$181.97	$302.00	$933.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $77.62 / $275.42	Professional	26	$63.10	$77.62	$275.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $181.97 / $588.84	Professional	TC	$117.49	$181.97	$588.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $338.84 / $436.52	Professional		$147.91	$338.84	$436.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $112.20 / $138.04	Professional	26	$58.88	$112.20	$138.04
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $263.03 / $363.08	Professional	TC	$234.42	$263.03	$363.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $302.00 / $302.00	Facility		$302.00	$302.00	$302.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $77.62 / $109.65	Facility	26	$16.60	$77.62	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $363.08 / $645.65	Professional		$229.09	$363.08	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $114.82 / $213.80	Professional	26	$72.44	$114.82	$213.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $239.88 / $436.52	Professional	TC	$154.88	$239.88	$436.52
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $416.87 / $1,380.38	Facility		$234.42	$416.87	$1,380.38
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $128.82 / $1,479.11	Facility	26	$74.13	$128.82	$1,479.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $389.05 / $537.03	Professional		$229.09	$389.05	$537.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $123.03 / $173.78	Professional	26	$70.79	$123.03	$173.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $263.03 / $371.54	Professional	TC	$154.88	$263.03	$371.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $85.11	Professional		$32.36	$33.11	$85.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $316.23 / $380.19 / $436.52	Facility		$316.23	$380.19	$436.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $131.83 / $138.04	Facility	26	$102.33	$131.83	$138.04
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $288.40 / $288.40	Professional		$288.40	$288.40	$288.40
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $109.65 / $138.04	Professional	26	$75.86	$109.65	$138.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $251.19 / $323.59	Professional	TC	$186.21	$251.19	$323.59
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $269.15 / $269.15 / $269.15	Facility		$269.15	$269.15	$269.15
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $91.20 / $93.33	Facility	26	$91.20	$91.20	$93.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $416.87 / $562.34	Professional		$269.15	$416.87	$562.34
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $144.54 / $194.98	Professional	26	$93.33	$144.54	$194.98
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $295.12 / $371.54	Professional	TC	$177.83	$295.12	$371.54
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,148.15 / $1,548.82 / $3,019.95	Facility		$1,148.15	$1,548.82	$3,019.95
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $933.25 / $933.25 / $933.25	Facility	26	$933.25	$933.25	$933.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $389.05 / $501.19	Professional		$275.42	$389.05	$501.19
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $131.83 / $173.78	Professional	26	$93.33	$131.83	$173.78
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $257.04 / $346.74	Professional	TC	$177.83	$257.04	$346.74
United Facility/Professional Facility Modifier Low / Median / High Price $1,548.82 / $2,089.30 / $3,715.35	Facility		$1,548.82	$2,089.30	$3,715.35
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $323.59 / $549.54	Professional		$213.80	$323.59	$549.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $104.71 / $186.21	Professional	26	$72.44	$104.71	$186.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $218.78 / $354.81	Professional	TC	$134.90	$218.78	$354.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $234.42 / $389.05	Professional		$204.17	$234.42	$389.05
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $79.43 / $131.83	Professional	26	$69.18	$79.43	$131.83
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $154.88 / $257.04	Professional	TC	$134.90	$154.88	$257.04