Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $138.04 / $245.47	Facility	26	$104.71	$138.04	$245.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $446.68 / $1,202.26	Professional		$138.04	$446.68	$1,202.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $141.25 / $380.19	Professional	26	$66.07	$141.25	$380.19
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $263.03 / $1,778.28 / $2,137.96	Professional	50	$263.03	$1,778.28	$2,137.96
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $288.40 / $288.40 / $288.40	Professional	52	$288.40	$288.40	$288.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $338.84 / $616.60	Professional	TC	$158.49	$338.84	$616.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $426.58 / $851.14	Professional		$213.80	$426.58	$851.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $95.50 / $194.98	Professional	26	$60.26	$95.50	$194.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $316.23 / $645.65	Professional	TC	$151.36	$316.23	$645.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $446.68 / $562.34	Professional		$398.11	$446.68	$562.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $134.90 / $165.96	Professional	26	$120.23	$134.90	$165.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $316.23 / $398.11	Professional	TC	$275.42	$316.23	$398.11
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $128.82 / $245.47	Facility	26	$104.71	$128.82	$245.47
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $478.63 / $851.14	Professional		$275.42	$478.63	$851.14
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $131.83 / $213.80	Professional	26	$89.13	$131.83	$213.80
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $309.03 / $1,778.28 / $2,137.96	Professional	50	$309.03	$1,778.28	$2,137.96
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $288.40 / $288.40 / $288.40	Professional	52	$288.40	$288.40	$288.40
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $331.13 / $724.44	Professional	TC	$234.42	$331.13	$724.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $125.89 / $128.82	Facility	26	$104.71	$125.89	$128.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $117.49 / $144.54	Professional	26	$79.43	$117.49	$144.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $302.00 / $724.44	Professional	TC	$213.80	$302.00	$724.44
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $72.44 / $104.71	Facility	26	$15.49	$72.44	$104.71
Providence Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $478.63 / $741.31	Professional		$229.09	$478.63	$741.31
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $131.83 / $190.55	Professional	26	$63.10	$131.83	$190.55
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $363.08 / $794.33	Professional	TC	$151.36	$363.08	$794.33
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $467.74 / $616.60	Professional		$380.19	$467.74	$616.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $138.04 / $177.83	Professional	26	$114.82	$138.04	$177.83
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $331.13 / $436.52	Professional	TC	$263.03	$331.13	$436.52
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $407.38 / $676.08	Professional		$199.53	$407.38	$676.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $81.28 / $194.98	Professional	26	$58.88	$81.28	$194.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $302.00 / $489.78	Professional	TC	$138.04	$302.00	$489.78