Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.77 / $53.69 / $124.53	Facility	26	$37.77	$53.69	$124.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.39 / $91.95 / $378.75	Professional		$58.39	$91.95	$378.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.46 / $32.78 / $144.00	Professional	26	$23.46	$32.78	$144.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $23.98 / $46.46 / $427.24	Professional	52	$23.98	$46.46	$427.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.39 / $63.28 / $153.44	Professional	TC	$28.39	$63.28	$153.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.91 / $150.72 / $204.12	Professional		$89.91	$150.72	$204.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.47 / $54.21 / $78.67	Professional	26	$29.47	$54.21	$78.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.01 / $87.31 / $132.52	Professional	TC	$54.01	$87.31	$132.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $111.17 / $129.55 / $155.33	Professional		$111.17	$129.55	$155.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.92 / $60.35 / $69.53	Professional	26	$50.92	$60.35	$69.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $59.38 / $69.48 / $85.81	Professional	TC	$59.38	$69.48	$85.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $92.86 / $132.26 / $184.60	Professional		$92.86	$132.26	$184.60
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.23 / $53.71 / $85.94	Professional	26	$43.23	$53.71	$85.94
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.63 / $63.18 / $98.66	Professional	TC	$49.63	$63.18	$98.66
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $37.72 / $52.02 / $54.94	Facility	26	$37.72	$52.02	$54.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $35.11 / $46.04 / $54.67	Professional	26	$35.11	$46.04	$54.67
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $56.68 / $87.21 / $120.06	Professional	TC	$56.68	$87.21	$120.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $107.01 / $144.91 / $194.77	Professional		$107.01	$144.91	$194.77
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.31 / $57.10 / $77.26	Professional	26	$34.31	$57.10	$77.26
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $67.38 / $67.38 / $73.80	Professional	52	$67.38	$67.38	$73.80
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $55.82 / $87.31 / $136.96	Professional	TC	$55.82	$87.31	$136.96
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 $107.10 / $140.47 / $189.33	Professional		$107.10	$140.47	$189.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.08 / $65.64 / $77.70	Professional	26	$49.08	$65.64	$77.70
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $55.44 / $75.48 / $110.72	Professional	TC	$55.44	$75.48	$110.72
United Facility/Professional Professional Modifier Low / Median / High Price $80.48 / $92.96 / $196.45	Professional		$80.48	$92.96	$196.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.03 / $31.96 / $84.75	Professional	26	$28.03	$31.96	$84.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.89 / $61.98 / $124.20	Professional	TC	$50.89	$61.98	$124.20