Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.71 / $78.50 / $160.66	Facility	26	$47.71	$78.50	$160.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $94.05 / $115.47 / $463.00	Professional		$94.05	$115.47	$463.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.67 / $37.54 / $95.38	Professional	26	$32.67	$37.54	$95.38
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $119.27 / $570.00 / $723.00	Professional	50	$119.27	$570.00	$723.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.48 / $74.31 / $174.77	Professional	TC	$65.48	$74.31	$174.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $119.16 / $222.93 / $302.88	Professional		$119.16	$222.93	$302.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.25 / $72.33 / $101.29	Professional	26	$40.25	$72.33	$101.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.18 / $146.44 / $201.59	Professional	TC	$78.18	$146.44	$201.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $195.66 / $228.02 / $276.19	Professional		$195.66	$228.02	$276.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $65.48 / $77.42 / $89.42	Professional	26	$65.48	$77.42	$89.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $129.22 / $151.22 / $186.78	Professional	TC	$129.22	$151.22	$186.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $163.32 / $183.60 / $324.64	Professional		$163.32	$183.60	$324.64
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.51 / $68.95 / $110.34	Professional	26	$55.51	$68.95	$110.34
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $146.82 / $146.82 / $161.00	Professional	50	$146.82	$146.82	$161.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.81 / $142.32 / $214.32	Professional	TC	$107.81	$142.32	$214.32
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $50.39 / $68.47 / $69.68	Facility	26	$50.39	$68.47	$69.68
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $45.32 / $59.07 / $71.76	Professional	26	$45.32	$59.07	$71.76
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $96.00 / $120.60 / $142.93	Professional	TC	$96.00	$120.60	$142.93
Providence Facility/Professional Professional Modifier Low / Median / High Price $180.54 / $227.92 / $300.70	Professional		$180.54	$227.92	$300.70
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.40 / $75.81 / $101.29	Professional	26	$46.40	$75.81	$101.29
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $93.62 / $152.37 / $201.59	Professional	TC	$93.62	$152.37	$201.59
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $186.66 / $246.95 / $294.67	Professional		$186.66	$246.95	$294.67
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $63.09 / $82.68 / $98.54	Professional	26	$63.09	$82.68	$98.54
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $123.89 / $165.86 / $196.13	Professional	TC	$123.89	$165.86	$196.13
United Facility/Professional Professional Modifier Low / Median / High Price $108.99 / $120.58 / $312.14	Professional		$108.99	$120.58	$312.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.17 / $41.37 / $106.45	Professional	26	$37.17	$41.37	$106.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.81 / $79.20 / $205.69	Professional	TC	$71.81	$79.20	$205.69