Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.70 / $64.70 / $141.72	Facility	26	$39.70	$64.70	$141.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.14 / $63.60 / $228.00	Professional		$50.14	$63.60	$228.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.57 / $43.49 / $140.44	Professional	26	$26.57	$43.49	$140.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.75 / $68.98 / $299.00	Professional	52	$24.75	$68.98	$299.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.46 / $29.02 / $134.00	Professional	TC	$22.46	$29.02	$134.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.40 / $32.40 / $32.40	Facility	26	$32.40	$32.40	$32.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.86 / $104.15 / $152.15	Professional		$59.86	$104.15	$152.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.94 / $56.08 / $82.21	Professional	26	$32.94	$56.08	$82.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.05 / $49.03 / $70.20	Professional	TC	$28.05	$49.03	$70.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $103.26 / $122.07 / $139.86	Professional		$103.26	$122.07	$139.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.36 / $64.98 / $73.16	Professional	26	$54.36	$64.98	$73.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.56 / $56.79 / $66.70	Professional	TC	$47.56	$56.79	$66.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $83.79 / $100.75 / $160.62	Professional		$83.79	$100.75	$160.62
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.36 / $59.93 / $90.17	Professional	26	$45.36	$59.93	$90.17
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $72.80 / $72.80 / $72.80	Professional	52	$72.80	$72.80	$72.80
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.43 / $50.77 / $73.20	Professional	TC	$38.43	$50.77	$73.20
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $41.67 / $56.03 / $57.62	Facility	26	$41.67	$56.03	$57.62
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $34.17 / $46.75 / $63.00	Professional	26	$34.17	$46.75	$63.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.14 / $40.65 / $52.50	Professional	TC	$28.14	$40.65	$52.50
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $32.40 / $32.40 / $32.40	Facility	26	$32.40	$32.40	$32.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $86.23 / $115.44 / $152.15	Professional		$86.23	$115.44	$152.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.15 / $57.94 / $82.60	Professional	26	$38.15	$57.94	$82.60
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $60.41 / $60.41 / $60.41	Professional	52	$60.41	$60.41	$60.41
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.71 / $50.86 / $70.80	Professional	TC	$31.71	$50.86	$70.80
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $64.77 / $64.77 / $64.77	Facility	26	$64.77	$64.77	$64.77
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $94.56 / $109.66 / $148.97	Professional		$94.56	$109.66	$148.97
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $51.47 / $60.14 / $81.48	Professional	26	$51.47	$60.14	$81.48
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $43.09 / $50.04 / $68.22	Professional	TC	$43.09	$50.04	$68.22
United Facility/Professional Professional Modifier Low / Median / High Price $61.53 / $69.73 / $160.21	Professional		$61.53	$69.73	$160.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.50 / $36.61 / $87.87	Professional	26	$33.50	$36.61	$87.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.78 / $31.32 / $72.23	Professional	TC	$27.78	$31.32	$72.23