Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.09 / $78.52 / $149.28	Facility	26	$50.09	$78.52	$149.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.73 / $188.62 / $580.79	Professional		$124.73	$188.62	$580.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.72 / $50.09 / $154.22	Professional	26	$32.72	$50.09	$154.22
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $40.02 / $564.00 / $762.00	Professional	52	$40.02	$564.00	$762.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.36 / $110.18 / $276.93	Professional	TC	$89.36	$110.18	$276.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $41.28	Facility	26	$41.28	$41.28	$41.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $148.15 / $260.57 / $377.62	Professional		$148.15	$260.57	$377.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.78 / $70.76 / $104.09	Professional	26	$40.78	$70.76	$104.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.81 / $189.81 / $272.39	Professional	TC	$109.81	$189.81	$272.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $253.90 / $301.57 / $349.15	Professional		$253.90	$301.57	$349.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.03 / $79.45 / $92.89	Professional	26	$69.03	$79.45	$92.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $182.75 / $218.21 / $256.23	Professional	TC	$182.75	$218.21	$256.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $205.47 / $234.00 / $391.41	Professional		$205.47	$234.00	$391.41
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.63 / $75.91 / $114.57	Professional	26	$57.63	$75.91	$114.57
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.84 / $195.82 / $281.61	Professional	TC	$147.84	$195.82	$281.61
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $55.65 / $71.14 / $73.03	Facility	26	$55.65	$71.14	$73.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $42.69 / $58.85 / $71.69	Professional	26	$42.69	$58.85	$71.69
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $120.40 / $152.35 / $187.60	Professional	TC	$120.40	$152.35	$187.60
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $41.28	Facility	26	$41.28	$41.28	$41.28
Providence Facility/Professional Professional Modifier Low / Median / High Price $206.51 / $280.49 / $375.78	Professional		$206.51	$280.49	$375.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.22 / $72.65 / $104.97	Professional	26	$48.22	$72.65	$104.97
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $178.00 / $178.00 / $178.00	Professional	52	$178.00	$178.00	$178.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $125.03 / $198.78 / $276.52	Professional	TC	$125.03	$198.78	$276.52
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $257.25 / $257.25 / $257.25	Facility	26	$257.25	$257.25	$257.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $230.42 / $298.18 / $364.79	Professional		$230.42	$298.18	$364.79
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.64 / $83.09 / $102.33	Professional	26	$64.64	$83.09	$102.33
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $165.78 / $212.59 / $262.45	Professional	TC	$165.78	$212.59	$262.45
United Facility/Professional Professional Modifier Low / Median / High Price $144.44 / $181.10 / $398.98	Professional		$144.44	$181.10	$398.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.26 / $48.65 / $112.49	Professional	26	$40.26	$48.65	$112.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.80 / $123.96 / $283.64	Professional	TC	$104.80	$123.96	$283.64