Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $107.15 / $213.80	Facility	26	$64.57	$107.15	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $275.42 / $630.96	Professional		$169.82	$275.42	$630.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $81.28 / $257.04	Professional	26	$52.48	$81.28	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $190.55 / $380.19	Professional	TC	$114.82	$190.55	$380.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $42.66 / $100.00	Professional	26	$42.66	$42.66	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $338.84 / $602.56	Professional		$177.83	$338.84	$602.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $85.11 / $169.82	Professional	26	$48.98	$85.11	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $251.19 / $457.09	Professional	TC	$117.49	$251.19	$457.09
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $114.82 / $489.78	Facility	26	$66.07	$114.82	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $407.38 / $537.03	Professional		$245.47	$407.38	$537.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $107.15 / $147.91	Professional	26	$56.23	$107.15	$147.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $302.00 / $407.38	Professional	TC	$173.78	$302.00	$407.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $75.86	Professional		$32.36	$33.11	$75.86
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $112.20 / $117.49	Facility	26	$95.50	$112.20	$117.49
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $104.71 / $128.82	Professional	26	$77.62	$104.71	$128.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $302.00 / $389.05	Professional	TC	$190.55	$302.00	$389.05
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $77.62 / $79.43	Facility	26	$77.62	$77.62	$79.43
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $389.05 / $512.86	Professional		$239.88	$389.05	$512.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $123.03 / $165.96	Professional	26	$79.43	$123.03	$165.96
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $269.15 / $346.74	Professional	TC	$162.18	$269.15	$346.74
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.74 / $346.74 / $346.74	Facility	26	$346.74	$346.74	$346.74
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $371.54 / $512.86	Professional		$245.47	$371.54	$512.86
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $123.03 / $162.18	Professional	26	$81.28	$123.03	$162.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $251.19 / $354.81	Professional	TC	$165.96	$251.19	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $263.03 / $537.03	Professional		$169.82	$263.03	$537.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $64.57 / $154.88	Professional	26	$50.12	$64.57	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $186.21 / $380.19	Professional	TC	$117.49	$186.21	$380.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $204.17 / $331.13	Professional		$177.83	$204.17	$331.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $66.07 / $107.15	Professional	26	$56.23	$66.07	$107.15
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $138.04 / $223.87	Professional	TC	$120.23	$138.04	$223.87