Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $128.82 / $194.98	Facility	26	$79.43	$128.82	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $173.78 / $588.84	Professional		$131.83	$173.78	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $89.13 / $275.42	Professional	26	$54.95	$89.13	$275.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $97.72 / $239.88	Professional	TC	$67.61	$97.72	$239.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $234.42 / $234.42	Professional		$234.42	$234.42	$234.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $117.49 / $131.83	Professional	26	$51.29	$117.49	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $251.19 / $426.58	Professional		$123.03	$251.19	$426.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $102.33 / $199.53	Professional	26	$56.23	$102.33	$199.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $134.90 / $245.47	Professional	TC	$63.10	$134.90	$245.47
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $107.15 / $162.18	Facility	26	$63.10	$107.15	$162.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $251.19 / $363.08	Professional		$141.25	$251.19	$363.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $107.15 / $162.18	Professional	26	$60.26	$107.15	$162.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $138.04 / $199.53	Professional	TC	$81.28	$138.04	$199.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $43.65	Professional		$32.36	$33.11	$43.65
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $131.83 / $141.25	Facility	26	$93.33	$131.83	$141.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $97.72 / $138.04	Professional	26	$74.13	$97.72	$138.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $125.89 / $186.21	Professional	TC	$87.10	$125.89	$186.21
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $93.33 / $93.33	Facility	26	$93.33	$93.33	$93.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $309.03 / $389.05	Professional		$190.55	$309.03	$389.05
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $147.91 / $199.53	Professional	26	$93.33	$147.91	$199.53
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $147.91 / $208.93	Professional	TC	$97.72	$147.91	$208.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $281.84 / $389.05	Professional		$194.98	$281.84	$389.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $138.04 / $190.55	Professional	26	$95.50	$138.04	$190.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $144.54 / $199.53	Professional	TC	$100.00	$144.54	$199.53
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $169.82 / $398.11	Professional		$109.65	$169.82	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $74.13 / $181.97	Professional	26	$47.86	$74.13	$181.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $89.13 / $218.78	Professional	TC	$60.26	$89.13	$218.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $144.54 / $239.88	Professional		$125.89	$144.54	$239.88
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $77.62 / $128.82	Professional	26	$67.61	$77.62	$128.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $67.61 / $112.20	Professional	TC	$58.88	$67.61	$112.20