Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $109.65 / $165.96	Facility	26	$75.86	$109.65	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $190.55 / $575.44	Professional		$63.10	$190.55	$575.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $69.18 / $218.78	Professional	26	$45.71	$69.18	$218.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $199.53 / $199.53 / $199.53	Professional	50	$199.53	$199.53	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $190.55 / $316.23	Professional	TC	$100.00	$190.55	$316.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $295.12 / $562.34	Professional		$165.96	$295.12	$562.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $69.18 / $138.04	Professional	26	$44.67	$69.18	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $213.80 / $426.58	Professional	TC	$123.03	$213.80	$426.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $354.81 / $446.68	Professional		$309.03	$354.81	$446.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $100.00 / $120.23	Professional	26	$87.10	$100.00	$120.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $257.04 / $323.59	Professional	TC	$223.87	$257.04	$323.59
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $95.50 / $165.96	Facility	26	$85.11	$95.50	$165.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $331.13 / $489.78	Professional		$186.21	$331.13	$489.78
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $95.50 / $141.25	Professional	26	$56.23	$95.50	$141.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $251.19 / $371.54	Professional	TC	$173.78	$251.19	$371.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $93.33 / $95.50	Facility	26	$77.62	$93.33	$95.50
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $67.61 / $151.36	Professional		$67.61	$67.61	$151.36
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $85.11 / $102.33	Professional	26	$57.54	$85.11	$102.33
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $234.42 / $331.13	Professional	TC	$158.49	$234.42	$331.13
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $363.08 / $489.78	Professional		$181.97	$363.08	$489.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $97.72 / $138.04	Professional	26	$46.77	$97.72	$138.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $269.15 / $398.11	Professional	TC	$123.03	$269.15	$398.11
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $363.08 / $467.74	Professional		$302.00	$363.08	$467.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $100.00 / $128.82	Professional	26	$85.11	$100.00	$128.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $263.03 / $331.13	Professional	TC	$218.78	$263.03	$331.13
United Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $251.19 / $501.19	Professional		$154.88	$251.19	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $63.10 / $134.90	Professional	26	$43.65	$63.10	$134.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $186.21 / $371.54	Professional	TC	$109.65	$186.21	$371.54