Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.00 / $139.91 / $262.20	Facility	26	$104.00	$139.91	$262.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $176.41 / $475.00 / $1,190.00	Professional		$176.41	$475.00	$1,190.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.00 / $140.00 / $377.00	Professional	26	$70.00	$140.00	$377.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,218.00 / $1,218.00 / $1,218.00	Professional	50	$1,218.00	$1,218.00	$1,218.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $105.18 / $237.50 / $322.61	Professional	52	$105.18	$237.50	$322.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $161.74 / $335.00 / $523.95	Professional	TC	$161.74	$335.00	$523.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $224.56 / $444.01 / $700.00	Professional		$224.56	$444.01	$700.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.41 / $116.08 / $187.83	Professional	26	$63.41	$116.08	$187.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $159.44 / $317.83 / $522.04	Professional	TC	$159.44	$317.83	$522.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $408.78 / $458.62 / $560.97	Professional		$408.78	$458.62	$560.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $122.30 / $141.85 / $164.63	Professional	26	$122.30	$141.85	$164.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $282.70 / $320.93 / $396.35	Professional	TC	$282.70	$320.93	$396.35
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $340.94 / $471.29 / $833.28	Professional		$340.94	$471.29	$833.28
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $101.94 / $125.96 / $196.20	Professional	26	$101.94	$125.96	$196.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $228.97 / $326.11 / $718.58	Professional	TC	$228.97	$326.11	$718.58
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $95.06 / $126.07 / $130.65	Facility	26	$95.06	$126.07	$130.65
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $178.16 / $220.31	Professional		$160.34	$178.16	$220.31
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $78.79 / $117.16 / $137.47	Professional	26	$78.79	$117.16	$137.47
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $209.84 / $312.06 / $718.62	Professional	TC	$209.84	$312.06	$718.62
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $341.85 / $491.44 / $625.84	Professional		$341.85	$491.44	$625.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.73 / $117.96 / $188.42	Professional	26	$66.73	$117.96	$188.42
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $245.49 / $245.49 / $246.99	Professional	52	$245.49	$245.49	$246.99
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $159.44 / $304.47 / $492.83	Professional	TC	$159.44	$304.47	$492.83
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $782.93 / $782.93 / $782.93	Facility	26	$782.93	$782.93	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $378.25 / $494.85 / $620.47	Professional		$378.25	$494.85	$620.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $115.51 / $137.26 / $182.87	Professional	26	$115.51	$137.26	$182.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $262.74 / $339.65 / $434.77	Professional	TC	$262.74	$339.65	$434.77
United Facility/Professional Professional Modifier Low / Median / High Price $198.48 / $388.20 / $668.74	Professional		$198.48	$388.20	$668.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.26 / $78.31 / $201.23	Professional	26	$59.26	$78.31	$201.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.66 / $267.91 / $467.20	Professional	TC	$138.66	$267.91	$467.20