Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.05 / $64.34 / $153.05	Facility	26	$51.05	$64.34	$153.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.74 / $79.12 / $145.99	Professional		$63.74	$79.12	$145.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.28 / $30.91 / $74.84	Professional	26	$26.28	$30.91	$74.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $21.68 / $38.82 / $109.68	Professional	52	$21.68	$38.82	$109.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.04 / $49.54 / $95.96	Professional	TC	$35.04	$49.54	$95.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.38 / $148.71 / $205.09	Professional		$82.38	$148.71	$205.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.15 / $63.78 / $87.52	Professional	26	$34.15	$63.78	$87.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.28 / $85.13 / $120.65	Professional	TC	$51.28	$85.13	$120.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $130.80 / $152.43 / $184.18	Professional		$130.80	$152.43	$184.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.80 / $67.54 / $78.93	Professional	26	$57.80	$67.54	$78.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.84 / $85.22 / $105.25	Professional	TC	$72.84	$85.22	$105.25
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $104.72 / $126.60 / $204.33	Professional		$104.72	$126.60	$204.33
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.03 / $57.55 / $95.48	Professional	26	$48.03	$57.55	$95.48
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $60.85 / $79.84 / $120.97	Professional	TC	$60.85	$79.84	$120.97
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.12 / $57.78 / $59.84	Facility	26	$43.12	$57.78	$59.84
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $73.34 / $73.34 / $73.34	Professional		$73.34	$73.34	$73.34
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $40.04 / $52.78 / $62.75	Professional	26	$40.04	$52.78	$62.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $59.50 / $77.02 / $103.50	Professional	TC	$59.50	$77.02	$103.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $114.68 / $154.16 / $196.98	Professional		$114.68	$154.16	$196.98
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $65.23 / $87.52	Professional	26	$39.81	$65.23	$87.52
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $73.80 / $73.80 / $76.67	Professional	52	$73.80	$73.80	$76.67
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $49.83 / $86.38 / $120.99	Professional	TC	$49.83	$86.38	$120.99
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $120.30 / $158.74 / $190.45	Professional		$120.30	$158.74	$190.45
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $53.90 / $70.64 / $84.33	Professional	26	$53.90	$70.64	$84.33
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $68.31 / $91.50 / $106.12	Professional	TC	$68.31	$91.50	$106.12
United Facility/Professional Professional Modifier Low / Median / High Price $67.84 / $85.62 / $212.34	Professional		$67.84	$85.62	$212.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $35.86 / $94.69	Professional	26	$31.62	$35.86	$94.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.09 / $53.90 / $119.14	Professional	TC	$36.09	$53.90	$119.14