Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.35 / $65.09 / $116.24	Facility	26	$45.35	$65.09	$116.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.34 / $203.91 / $492.71	Professional		$113.34	$203.91	$492.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $50.35 / $144.83	Professional	26	$29.75	$50.35	$144.83
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $46.22 / $75.03 / $273.00	Professional	52	$46.22	$75.03	$273.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.59 / $121.20 / $240.70	Professional	TC	$83.59	$121.20	$240.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $124.88 / $246.34 / $352.05	Professional		$124.88	$246.34	$352.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.56 / $68.36 / $96.23	Professional	26	$37.56	$68.36	$96.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $82.52 / $182.25 / $256.19	Professional	TC	$82.52	$182.25	$256.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $225.75 / $259.86 / $320.02	Professional		$225.75	$259.86	$320.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.89 / $73.16 / $84.51	Professional	26	$61.89	$73.16	$84.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $162.99 / $190.69 / $235.51	Professional	TC	$162.99	$190.69	$235.51
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $171.27 / $200.20 / $366.99	Professional		$171.27	$200.20	$366.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.31 / $62.98 / $103.98	Professional	26	$52.31	$62.98	$103.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $136.09 / $168.78 / $270.52	Professional	TC	$136.09	$168.78	$270.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $48.51 / $64.70 / $66.33	Facility	26	$48.51	$64.70	$66.33
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $78.25 / $78.25	Professional		$78.25	$78.25	$78.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $39.79 / $55.85 / $71.28	Professional	26	$39.79	$55.85	$71.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $100.10 / $141.00 / $182.16	Professional	TC	$100.10	$141.00	$182.16
Providence Facility/Professional Professional Modifier Low / Median / High Price $193.03 / $259.02 / $348.53	Professional		$193.03	$259.02	$348.53
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.13 / $72.09 / $95.39	Professional	26	$44.13	$72.09	$95.39
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $139.78 / $139.78 / $139.78	Professional	52	$139.78	$139.78	$139.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $98.25 / $190.49 / $253.11	Professional	TC	$98.25	$190.49	$253.11
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 $216.06 / $287.04 / $342.05	Professional		$216.06	$287.04	$342.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.03 / $78.66 / $93.80	Professional	26	$60.03	$78.66	$93.80
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $156.81 / $211.10 / $248.24	Professional	TC	$156.81	$211.10	$248.24
United Facility/Professional Professional Modifier Low / Median / High Price $124.33 / $147.81 / $400.70	Professional		$124.33	$147.81	$400.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.11 / $38.75 / $101.30	Professional	26	$35.11	$38.75	$101.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.40 / $102.06 / $256.95	Professional	TC	$88.40	$102.06	$256.95