Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.33 / $30.57 / $45.31	Facility	26	$25.33	$30.57	$45.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.52 / $88.12 / $359.75	Professional		$54.52	$88.12	$359.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.39 / $20.46 / $93.97	Professional	26	$16.39	$20.46	$93.97
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $200.26 / $200.26 / $200.26	Professional	50	$200.26	$200.26	$200.26
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $27.26 / $33.52 / $82.32	Professional	52	$27.26	$33.52	$82.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.11 / $47.07 / $97.24	Professional	TC	$38.11	$47.07	$97.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.65 / $20.65 / $20.65	Facility	26	$20.65	$20.65	$20.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.65 / $131.69 / $181.93	Professional		$71.65	$131.69	$181.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.08 / $38.04 / $52.17	Professional	26	$23.08	$38.04	$52.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.67 / $92.86 / $128.82	Professional	TC	$48.67	$92.86	$128.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.73 / $140.47 / $162.81	Professional		$107.73	$140.47	$162.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.94 / $41.65 / $47.02	Professional	26	$31.94	$41.65	$47.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.79 / $98.61 / $115.79	Professional	TC	$75.79	$98.61	$115.79
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $95.54 / $110.98 / $188.07	Professional		$95.54	$110.98	$188.07
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.83 / $34.94 / $57.30	Professional	26	$28.83	$34.94	$57.30
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $66.70 / $88.14 / $132.61	Professional	TC	$66.70	$88.14	$132.61
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $26.16 / $35.51 / $36.18	Facility	26	$26.16	$35.51	$36.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $21.46 / $27.14 / $36.40	Professional	26	$21.46	$27.14	$36.40
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $45.02 / $63.84 / $87.77	Professional	TC	$45.02	$63.84	$87.77
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $20.65 / $20.65 / $20.65	Facility	26	$20.65	$20.65	$20.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $85.85 / $132.59 / $172.51	Professional		$85.85	$132.59	$172.51
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.24 / $38.04 / $52.17	Professional	26	$24.24	$38.04	$52.17
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $48.79 / $93.66 / $128.82	Professional	TC	$48.79	$93.66	$128.82
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $99.90 / $123.30 / $175.29	Professional		$99.90	$123.30	$175.29
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.62 / $35.65 / $50.22	Professional	26	$28.62	$35.65	$50.22
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $68.59 / $87.98 / $125.07	Professional	TC	$68.59	$87.98	$125.07
United Facility/Professional Professional Modifier Low / Median / High Price $81.42 / $123.90 / $190.88	Professional		$81.42	$123.90	$190.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.63 / $38.15 / $54.91	Professional	26	$25.63	$38.15	$54.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.95 / $84.32 / $135.78	Professional	TC	$66.95	$84.32	$135.78