Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $81.28 / $114.82	Facility	26	$47.86	$81.28	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $120.23 / $416.87	Professional		$72.44	$120.23	$416.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $42.66 / $138.04	Professional	26	$28.84	$42.66	$138.04
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $107.15 / $323.59 / $776.25	Professional	50	$107.15	$323.59	$776.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $75.86 / $154.88	Professional	TC	$54.95	$75.86	$154.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $199.53 / $295.12	Professional		$109.65	$199.53	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $64.57 / $100.00	Professional	26	$38.90	$64.57	$100.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $131.83 / $199.53	Professional	TC	$72.44	$131.83	$199.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $213.80 / $263.03	Professional		$169.82	$213.80	$263.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $70.79 / $85.11	Professional	26	$54.95	$70.79	$85.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $144.54 / $177.83	Professional	TC	$117.49	$144.54	$177.83
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $69.18 / $114.82	Facility	26	$47.86	$69.18	$114.82
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $199.53 / $302.00	Professional		$114.82	$199.53	$302.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $70.79 / $102.33	Professional	26	$36.31	$70.79	$102.33
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $46.77 / $234.42 / $776.25	Professional	50	$46.77	$234.42	$776.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $134.90 / $199.53	Professional	TC	$75.86	$134.90	$199.53
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $69.18 / $69.18	Facility	26	$56.23	$69.18	$69.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $56.23 / $72.44	Professional	26	$41.69	$56.23	$72.44
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $117.49 / $141.25	Professional	TC	$85.11	$117.49	$141.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $213.80 / $295.12	Professional		$165.96	$213.80	$295.12
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $70.79 / $100.00	Professional	26	$46.77	$70.79	$100.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $138.04 / $199.53	Professional	TC	$93.33	$138.04	$199.53
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 $186.21 / $218.78 / $281.84	Professional		$186.21	$218.78	$281.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $74.13 / $95.50	Professional	26	$63.10	$74.13	$95.50
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $144.54 / $186.21	Professional	TC	$123.03	$144.54	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $120.23 / $269.15	Professional		$104.71	$120.23	$269.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $39.81 / $93.33	Professional	26	$35.48	$39.81	$93.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $77.62 / $177.83	Professional	TC	$69.18	$77.62	$177.83