Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.27 / $86.17 / $146.16	Professional		$56.27	$86.17	$146.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.69 / $30.46 / $60.53	Professional	26	$23.69	$30.46	$60.53
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $28.14 / $43.09 / $50.61	Professional	52	$28.14	$43.09	$50.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.58 / $52.82 / $72.31	Professional	TC	$32.58	$52.82	$72.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.87 / $118.24 / $178.90	Professional		$63.87	$118.24	$178.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.12 / $50.29 / $76.87	Professional	26	$28.12	$50.29	$76.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.29 / $72.42 / $104.24	Professional	TC	$36.29	$72.42	$104.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $65.70 / $134.59 / $156.75	Professional		$65.70	$134.59	$156.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.60 / $56.51 / $63.45	Professional	26	$26.60	$56.51	$63.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.11 / $78.08 / $93.29	Professional	TC	$39.11	$78.08	$93.29
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $51.22 / $82.61 / $177.61	Facility		$51.22	$82.61	$177.61
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $72.00 / $105.56 / $148.85	Professional		$72.00	$105.56	$148.85
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.62 / $42.30 / $68.47	Professional	26	$28.62	$42.30	$68.47
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.85 / $58.71 / $86.94	Professional	TC	$39.85	$58.71	$86.94
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $71.56 / $119.26 / $132.86	Facility		$71.56	$119.26	$132.86
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.28 / $52.26 / $54.27	Facility	26	$38.28	$52.26	$54.27
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.54 / $40.70 / $55.69	Professional	26	$33.54	$40.70	$55.69
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $45.33 / $65.83 / $83.62	Professional	TC	$45.33	$65.83	$83.62
Providence Facility/Professional Facility Modifier Low / Median / High Price $59.14 / $84.84 / $177.61	Facility		$59.14	$84.84	$177.61
Providence Facility/Professional Professional Modifier Low / Median / High Price $79.51 / $120.53 / $167.90	Professional		$79.51	$120.53	$167.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.20 / $50.29 / $76.87	Professional	26	$29.20	$50.29	$76.87
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $39.72 / $72.45 / $104.24	Professional	TC	$39.72	$72.45	$104.24
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $71.87 / $117.77 / $172.05	Professional		$71.87	$117.77	$172.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $30.52 / $50.02 / $73.09	Professional	26	$30.52	$50.02	$73.09
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.34 / $67.75 / $98.98	Professional	TC	$41.34	$67.75	$98.98
United Facility/Professional Professional Modifier Low / Median / High Price $69.42 / $103.24 / $175.14	Professional		$69.42	$103.24	$175.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.42 / $45.24 / $76.75	Professional	26	$30.42	$45.24	$76.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.31 / $60.18 / $102.40	Professional	TC	$43.31	$60.18	$102.40