Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $147.91 / $213.80 / $338.84	Facility	26	$147.91	$213.80	$338.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $812.83 / $1,778.28	Professional		$588.84	$812.83	$1,778.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $190.55 / $575.44	Professional	26	$114.82	$190.55	$575.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $371.54 / $1,258.93	Professional	52	$199.53	$371.54	$1,258.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $660.69 / $1,445.44	Professional	TC	$467.74	$660.69	$1,445.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $707.95 / $1,621.81	Professional		$537.03	$707.95	$1,621.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $234.42 / $257.04	Professional	26	$109.65	$234.42	$257.04
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $1,380.38 / $1,380.38 / $1,380.38	Professional	TC	$1,380.38	$1,380.38	$1,380.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $1,174.90 / $1,995.26	Professional		$724.44	$1,174.90	$1,995.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $213.80 / $363.08	Professional	26	$134.90	$213.80	$363.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $954.99 / $1,659.59	Professional	TC	$588.84	$954.99	$1,659.59
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $190.55 / $316.23	Facility	26	$117.49	$190.55	$316.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $912.01 / $1,548.82	Professional		$588.84	$912.01	$1,548.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $177.83 / $275.42	Professional	26	$109.65	$177.83	$275.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $741.31 / $1,258.93	Professional	TC	$478.63	$741.31	$1,258.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $436.52	Professional		$32.36	$33.11	$436.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $239.88 / $245.47	Facility	26	$199.53	$239.88	$245.47
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $537.03 / $537.03	Professional		$537.03	$537.03	$537.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $213.80 / $323.59	Professional	26	$147.91	$213.80	$323.59
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $891.25 / $1,202.26	Professional	TC	$630.96	$891.25	$1,202.26
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $162.18 / $165.96	Facility	26	$162.18	$162.18	$165.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $1,348.96 / $1,862.09	Professional		$891.25	$1,348.96	$1,862.09
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $257.04 / $354.81	Professional	26	$165.96	$257.04	$354.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $724.44 / $1,096.48 / $1,548.82	Professional	TC	$724.44	$1,096.48	$1,548.82
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,778.28 / $1,778.28 / $1,778.28	Facility	26	$1,778.28	$1,778.28	$1,778.28
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $691.83 / $1,258.93	Professional		$630.96	$691.83	$1,258.93
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $125.89 / $275.42	Professional	26	$120.23	$125.89	$275.42
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $537.03 / $1,023.29	Professional	TC	$501.19	$537.03	$1,023.29
United Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $1,071.52 / $1,778.28	Professional		$676.08	$1,071.52	$1,778.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $213.80 / $354.81	Professional	26	$128.82	$213.80	$354.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $870.96 / $1,445.44	Professional	TC	$562.34	$870.96	$1,445.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $851.14 / $1,412.54	Professional		$741.31	$851.14	$1,412.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $134.90 / $239.88	Professional	26	$125.89	$134.90	$239.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $707.95 / $1,174.90	Professional	TC	$616.60	$707.95	$1,174.90