Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $81.28 / $144.54	Facility	26	$50.12	$81.28	$144.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $186.21 / $616.60	Professional		$107.15	$186.21	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $51.29 / $125.89	Professional	26	$32.36	$51.29	$125.89
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $34.67 / $120.23 / $758.58	Professional	52	$34.67	$120.23	$758.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $107.15 / $239.88	Professional	TC	$77.62	$107.15	$239.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $251.19 / $380.19	Professional		$141.25	$251.19	$380.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $66.07 / $104.71	Professional	26	$38.90	$66.07	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $181.97 / $275.42	Professional	TC	$102.33	$181.97	$275.42
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $457.09 / $457.09	Professional		$457.09	$457.09	$457.09
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $158.49 / $186.21	Professional	26	$151.36	$158.49	$186.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $275.42 / $346.74	Professional		$245.47	$275.42	$346.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $75.86 / $93.33	Professional	26	$66.07	$75.86	$93.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $199.53 / $257.04	Professional	TC	$177.83	$199.53	$257.04
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $70.79 / $134.90	Facility	26	$50.12	$70.79	$134.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $257.04 / $407.38	Professional		$141.25	$257.04	$407.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $72.44 / $112.20	Professional	26	$37.15	$72.44	$112.20
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $34.67 / $109.65 / $562.34	Professional	52	$34.67	$109.65	$562.34
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $186.21 / $275.42	Professional	TC	$100.00	$186.21	$275.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $70.79 / $72.44	Facility	26	$58.88	$70.79	$72.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $60.26 / $77.62	Professional	26	$43.65	$60.26	$77.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $169.82 / $199.53	Professional	TC	$128.82	$169.82	$199.53
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $41.69 / $58.88	Facility	26	$8.91	$41.69	$58.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $275.42 / $380.19	Professional		$213.80	$275.42	$380.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $75.86 / $107.15	Professional	26	$47.86	$75.86	$107.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $204.17 / $275.42	Professional	TC	$134.90	$204.17	$275.42
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $257.04 / $257.04 / $257.04	Facility	26	$257.04	$257.04	$257.04
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 $64.57 / $75.86 / $97.72	Professional	26	$64.57	$75.86	$97.72
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $194.98 / $251.19	Professional	TC	$165.96	$194.98	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $173.78 / $354.81	Professional		$138.04	$173.78	$354.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $48.98 / $97.72	Professional	26	$38.90	$48.98	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $123.03 / $263.03	Professional	TC	$100.00	$123.03	$263.03