Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $58.88 / $134.90	Facility	26	$38.02	$58.88	$134.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $91.20 / $436.52	Professional		$53.70	$91.20	$436.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $38.90 / $151.36	Professional	26	$23.44	$38.90	$151.36
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $53.70 / $81.28 / $446.68	Professional	52	$53.70	$81.28	$446.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $54.95 / $95.50	Professional	TC	$25.12	$54.95	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $123.03 / $199.53	Professional		$81.28	$123.03	$199.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $50.12 / $74.13	Professional	26	$28.18	$50.12	$74.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $70.79 / $131.83	Professional	TC	$45.71	$70.79	$131.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $125.89 / $154.88	Professional		$102.33	$125.89	$154.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $57.54 / $69.18	Professional	26	$44.67	$57.54	$69.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $70.79 / $85.11	Professional	TC	$58.88	$70.79	$85.11
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $52.48 / $79.43	Facility	26	$38.02	$52.48	$79.43
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $131.83 / $173.78	Professional		$87.10	$131.83	$173.78
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $56.23 / $83.18	Professional	26	$28.84	$56.23	$83.18
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $53.70 / $81.28 / $446.68	Professional	52	$53.70	$81.28	$446.68
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $69.18 / $97.72	Professional	TC	$50.12	$69.18	$97.72
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $52.48 / $54.95	Facility	26	$43.65	$52.48	$54.95
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Professional		$93.33	$93.33	$93.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $46.77 / $57.54	Professional	26	$35.48	$46.77	$57.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $91.20 / $120.23	Professional	TC	$48.98	$91.20	$120.23
Providence Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $144.54 / $190.55	Professional		$102.33	$144.54	$190.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $53.70 / $74.13	Professional	26	$36.31	$53.70	$74.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $89.13 / $138.04	Professional	TC	$53.70	$89.13	$138.04
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $141.25 / $190.55	Professional		$102.33	$141.25	$190.55
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $57.54 / $74.13	Professional	26	$47.86	$57.54	$74.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $75.86 / $123.03	Professional	TC	$54.95	$75.86	$123.03
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $89.13 / $194.98	Professional		$67.61	$89.13	$194.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $30.20 / $72.44	Professional	26	$26.92	$30.20	$72.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $61.66 / $117.49	Professional	TC	$41.69	$61.66	$117.49