Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $83.18 / $104.71	Facility	26	$52.48	$83.18	$104.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $147.91 / $537.03	Professional		$79.43	$147.91	$537.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $52.48 / $120.23	Professional	26	$33.88	$52.48	$120.23
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $602.56 / $602.56 / $602.56	Professional	52	$602.56	$602.56	$602.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $100.00 / $223.87	Professional	TC	$72.44	$100.00	$223.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $245.47 / $371.54	Professional		$138.04	$245.47	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $70.79 / $112.20	Professional	26	$41.69	$70.79	$112.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $173.78 / $263.03	Professional	TC	$97.72	$173.78	$263.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $275.42 / $338.84	Professional		$239.88	$275.42	$338.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $81.28 / $97.72	Professional	26	$70.79	$81.28	$97.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $186.21 / $245.47	Professional	TC	$165.96	$186.21	$245.47
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $74.13 / $104.71	Facility	26	$52.48	$74.13	$104.71
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $251.19 / $380.19	Professional		$128.82	$251.19	$380.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $77.62 / $120.23	Professional	26	$38.02	$77.62	$120.23
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $602.56 / $602.56 / $602.56	Professional	52	$602.56	$602.56	$602.56
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $177.83 / $263.03	Professional	TC	$93.33	$177.83	$263.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $75.86 / $77.62	Facility	26	$63.10	$75.86	$77.62
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $63.10 / $77.62	Professional	26	$45.71	$63.10	$77.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $158.49 / $177.83	Professional	TC	$120.23	$158.49	$177.83
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $43.65 / $61.66	Facility	26	$9.33	$43.65	$61.66
Providence Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $269.15 / $371.54	Professional		$208.93	$269.15	$371.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $81.28 / $112.20	Professional	26	$51.29	$81.28	$112.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $194.98 / $263.03	Professional	TC	$128.82	$194.98	$263.03
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $245.47 / $245.47 / $245.47	Facility	26	$245.47	$245.47	$245.47
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $269.15 / $346.74	Professional		$229.09	$269.15	$346.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $81.28 / $102.33	Professional	26	$67.61	$81.28	$102.33
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $186.21 / $239.88	Professional	TC	$158.49	$186.21	$239.88
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $169.82 / $346.74	Professional		$134.90	$169.82	$346.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $51.29 / $102.33	Professional	26	$41.69	$51.29	$102.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $117.49 / $245.47	Professional	TC	$95.50	$117.49	$245.47