Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $102.33 / $194.98	Facility	26	$57.54	$102.33	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $181.97 / $512.86	Professional		$93.33	$181.97	$512.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $64.57 / $141.25	Professional	26	$41.69	$64.57	$141.25
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.23 / $93.33 / $630.96	Professional	52	$10.23	$93.33	$630.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $95.50 / $162.18	Professional	TC	$46.77	$95.50	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $208.93 / $416.87	Professional		$117.49	$208.93	$416.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $89.13 / $158.49	Professional	26	$50.12	$89.13	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $120.23 / $257.04	Professional	TC	$66.07	$120.23	$257.04
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $120.23 / $120.23	Professional	26	$120.23	$120.23	$120.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $223.87 / $263.03	Professional		$186.21	$223.87	$263.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $95.50 / $114.82	Professional	26	$79.43	$95.50	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $131.83 / $147.91	Professional	TC	$100.00	$131.83	$147.91
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $100.00 / $194.98	Facility	26	$57.54	$100.00	$194.98
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $239.88 / $363.08	Professional		$147.91	$239.88	$363.08
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $95.50 / $147.91	Professional	26	$50.12	$95.50	$147.91
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $10.23 / $74.13 / $309.03	Professional	52	$10.23	$74.13	$309.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $125.89 / $218.78	Professional	TC	$69.18	$125.89	$218.78
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $85.11 / $117.49	Facility	26	$70.79	$85.11	$117.49
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $72.44	Professional		$72.44	$72.44	$72.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $91.20 / $125.89	Professional	26	$60.26	$91.20	$125.89
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $165.96 / $223.87	Professional	TC	$75.86	$165.96	$223.87
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $48.98 / $70.79	Facility	26	$10.47	$48.98	$70.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $229.09 / $371.54	Professional		$147.91	$229.09	$371.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $107.15 / $154.88	Professional	26	$61.66	$107.15	$154.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $147.91 / $239.88	Professional	TC	$83.18	$147.91	$239.88
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $457.09 / $457.09 / $457.09	Facility	26	$457.09	$457.09	$457.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $199.53 / $316.23	Professional		$141.25	$199.53	$316.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $91.20 / $120.23	Professional	26	$64.57	$91.20	$120.23
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $109.65 / $199.53	Professional	TC	$74.13	$109.65	$199.53
United Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $239.88 / $363.08	Professional		$151.36	$239.88	$363.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $97.72 / $141.25	Professional	26	$58.88	$97.72	$141.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $141.25 / $223.87	Professional	TC	$85.11	$141.25	$223.87