Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $275.42 / $707.95 / $1,318.26	Facility		$275.42	$707.95	$1,318.26
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $66.07 / $104.71	Facility	26	$47.86	$66.07	$104.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $234.42 / $630.96	Professional		$165.96	$234.42	$630.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $47.86 / $134.90	Professional	26	$33.88	$47.86	$134.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $169.82 / $398.11	Professional	TC	$128.82	$169.82	$398.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $181.97 / $371.54	Professional		$173.78	$181.97	$371.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $60.26 / $74.13	Professional	26	$30.90	$60.26	$74.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $239.88 / $239.88	Professional	TC	$239.88	$239.88	$239.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $478.63 / $870.96 / $1,148.15	Facility		$478.63	$870.96	$1,148.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $43.65 / $63.10	Facility	26	$9.33	$43.65	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $331.13 / $588.84	Professional		$204.17	$331.13	$588.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $58.88 / $117.49	Professional	26	$37.15	$58.88	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $269.15 / $478.63	Professional	TC	$162.18	$269.15	$478.63
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $380.19 / $691.83	Facility		$234.42	$380.19	$691.83
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $72.44 / $630.96	Facility	26	$36.31	$72.44	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $371.54 / $501.19	Professional		$234.42	$371.54	$501.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $67.61 / $93.33	Professional	26	$36.31	$67.61	$93.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $309.03 / $407.38	Professional	TC	$190.55	$309.03	$407.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $95.50	Professional		$32.36	$33.11	$95.50
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $354.81 / $426.58	Facility		$295.12	$354.81	$426.58
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $74.13 / $75.86	Facility	26	$60.26	$74.13	$75.86
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $56.23 / $77.62	Professional	26	$41.69	$56.23	$77.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $281.84 / $363.08	Professional	TC	$177.83	$281.84	$363.08
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $245.47 / $245.47	Facility		$245.47	$245.47	$245.47
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Facility	26	$51.29	$51.29	$51.29
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $389.05 / $524.81	Professional		$245.47	$389.05	$524.81
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $81.28 / $114.82	Professional	26	$51.29	$81.28	$114.82
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $316.23 / $426.58	Professional	TC	$194.98	$316.23	$426.58
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $478.63 / $691.83 / $1,318.26	Facility		$478.63	$691.83	$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 $251.19 / $354.81 / $467.74	Professional		$251.19	$354.81	$467.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $74.13 / $95.50	Professional	26	$52.48	$74.13	$95.50
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $281.84 / $363.08	Professional	TC	$199.53	$281.84	$363.08
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 $190.55 / $295.12 / $501.19	Professional		$190.55	$295.12	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $54.95 / $104.71	Professional	26	$38.02	$54.95	$104.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $239.88 / $398.11	Professional	TC	$151.36	$239.88	$398.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $213.80 / $354.81	Professional		$186.21	$213.80	$354.81
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $42.66 / $70.79	Professional	26	$37.15	$42.66	$70.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $173.78 / $288.40	Professional	TC	$151.36	$173.78	$288.40