Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.00 / $139.21 / $322.33	Facility	26	$104.00	$139.21	$322.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $183.96 / $475.00 / $1,190.00	Professional		$183.96	$475.00	$1,190.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.63 / $140.00 / $383.58	Professional	26	$66.63	$140.00	$383.58
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $475.00 / $475.00 / $475.00	Professional	50	$475.00	$475.00	$475.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $105.01 / $237.50 / $322.61	Professional	52	$105.01	$237.50	$322.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $164.81 / $335.00 / $698.59	Professional	TC	$164.81	$335.00	$698.59
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 $224.19 / $442.64 / $692.74	Professional		$224.19	$442.64	$692.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.74 / $116.08 / $187.83	Professional	26	$61.74	$116.08	$187.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $159.07 / $317.14 / $520.85	Professional	TC	$159.07	$317.14	$520.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $408.11 / $457.89 / $560.04	Professional		$408.11	$457.89	$560.04
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 $282.05 / $320.17 / $395.41	Professional	TC	$282.05	$320.17	$395.41
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $340.37 / $470.52 / $784.25	Professional		$340.37	$470.52	$784.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $101.94 / $125.96 / $195.18	Professional	26	$101.94	$125.96	$195.18
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $228.43 / $325.33 / $718.58	Professional	TC	$228.43	$325.33	$718.58
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $95.06 / $126.07 / $129.97	Facility	26	$95.06	$126.07	$129.97
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $178.16 / $178.16	Professional		$160.34	$178.16	$178.16
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $77.98 / $117.87 / $145.04	Professional	26	$77.98	$117.87	$145.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $199.50 / $308.57 / $722.19	Professional	TC	$199.50	$308.57	$722.19
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 $341.31 / $489.33 / $626.21	Professional		$341.31	$489.33	$626.21
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $65.12 / $116.08 / $187.83	Professional	26	$65.12	$116.08	$187.83
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $245.10 / $245.10 / $245.10	Professional	52	$245.10	$245.10	$245.10
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $159.07 / $304.47 / $492.83	Professional	TC	$159.07	$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 $377.65 / $494.08 / $617.60	Professional		$377.65	$494.08	$617.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $114.91 / $137.26 / $181.92	Professional	26	$114.91	$137.26	$181.92
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $262.74 / $338.92 / $433.83	Professional	TC	$262.74	$338.92	$433.83
United Facility/Professional Professional Modifier Low / Median / High Price $197.56 / $395.11 / $700.42	Professional		$197.56	$395.11	$700.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.90 / $76.30 / $198.14	Professional	26	$58.90	$76.30	$198.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.66 / $213.98 / $467.20	Professional	TC	$138.66	$213.98	$467.20