Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $93.33 / $120.23	Facility	26	$57.54	$93.33	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $89.13 / $162.18	Professional		$72.44	$89.13	$162.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $45.71 / $87.10	Professional	26	$38.90	$45.71	$87.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $43.65 / $89.13	Professional	TC	$33.88	$43.65	$89.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $81.28 / $125.89	Professional		$66.07	$81.28	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $144.54 / $269.15	Professional		$79.43	$144.54	$269.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $72.44 / $128.82	Professional	26	$44.67	$72.44	$128.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $70.79 / $138.04	Professional	TC	$33.88	$70.79	$138.04
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $61.66 / $114.82	Facility	26	$38.02	$61.66	$114.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $102.33 / $199.53	Professional		$66.07	$102.33	$199.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $58.88 / $100.00	Professional	26	$37.15	$58.88	$100.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $44.67 / $100.00	Professional	TC	$26.92	$44.67	$100.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $46.77	Professional		$32.36	$33.11	$46.77
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $85.11 / $87.10	Facility	26	$70.79	$85.11	$87.10
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $74.13 / $93.33	Professional	26	$53.70	$74.13	$93.33
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $60.26 / $87.10	Professional	TC	$46.77	$60.26	$87.10
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $58.88 / $58.88	Facility	26	$58.88	$58.88	$58.88
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $177.83 / $251.19	Professional		$120.23	$177.83	$251.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $89.13 / $125.89	Professional	26	$58.88	$89.13	$125.89
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $91.20 / $125.89	Professional	TC	$60.26	$91.20	$125.89
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $269.15 / $269.15 / $269.15	Facility	26	$269.15	$269.15	$269.15
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $165.96 / $218.78	Professional		$107.15	$165.96	$218.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $83.18 / $112.20	Professional	26	$53.70	$83.18	$112.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $81.28 / $112.20	Professional	TC	$53.70	$81.28	$112.20
United Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $125.89 / $239.88	Professional		$89.13	$125.89	$239.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $69.18 / $125.89	Professional	26	$46.77	$69.18	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $60.26 / $120.23	Professional	TC	$38.90	$60.26	$120.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $104.71 / $177.83	Professional		$93.33	$104.71	$177.83
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $48.98 / $85.11	Professional	26	$44.67	$48.98	$85.11
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $56.23 / $91.20	Professional	TC	$48.98	$56.23	$91.20