Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $105.67 / $118.07 / $360.36	Facility		$105.67	$118.07	$360.36
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.77 / $67.77 / $74.84	Facility	26	$67.77	$67.77	$74.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.13 / $80.39 / $156.00	Professional		$46.13	$80.39	$156.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.33 / $34.95 / $74.84	Professional	26	$28.33	$34.95	$74.84
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $56.53 / $326.11 / $334.86	Professional	50	$56.53	$326.11	$334.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $18.76 / $35.57 / $95.72	Professional	52	$18.76	$35.57	$95.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.26 / $52.74 / $106.51	Professional	TC	$16.26	$52.74	$106.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.81 / $128.05 / $191.94	Professional		$83.81	$128.05	$191.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.15 / $63.10 / $91.57	Professional	26	$34.15	$63.10	$91.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.65 / $62.06 / $107.01	Professional	TC	$36.65	$62.06	$107.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $90.41 / $105.36 / $125.84	Professional		$90.41	$105.36	$125.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.13 / $66.79 / $78.02	Professional	26	$57.13	$66.79	$78.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.10 / $38.72 / $47.82	Professional	TC	$33.10	$38.72	$47.82
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $47.37 / $101.73 / $219.12	Facility		$47.37	$101.73	$219.12
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $77.08 / $118.32 / $152.40	Professional		$77.08	$118.32	$152.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.50 / $58.16 / $94.43	Professional	26	$47.50	$58.16	$94.43
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.75 / $37.85 / $55.17	Professional	TC	$27.75	$37.85	$55.17
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $58.96 / $94.47 / $170.18	Facility		$58.96	$94.47	$170.18
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.12 / $59.07 / $59.63	Facility	26	$43.12	$59.07	$59.63
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $32.69 / $37.15 / $61.60	Professional		$32.69	$37.15	$61.60
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $35.78 / $48.23 / $66.75	Professional	26	$35.78	$48.23	$66.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.28 / $78.50 / $112.75	Professional	TC	$30.28	$78.50	$112.75
Providence Facility/Professional Facility Modifier Low / Median / High Price $48.47 / $117.24 / $207.36	Facility		$48.47	$117.24	$207.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $90.30 / $119.00 / $171.37	Professional		$90.30	$119.00	$171.37
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.36 / $65.23 / $86.73	Professional	26	$38.36	$65.23	$86.73
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $36.01 / $55.44 / $109.05	Professional	TC	$36.01	$55.44	$109.05
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $307.31 / $415.67 / $478.20	Facility		$307.31	$415.67	$478.20
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $354.01 / $354.01 / $354.01	Facility	26	$354.01	$354.01	$354.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $88.64 / $115.83 / $161.31	Professional		$88.64	$115.83	$161.31
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $55.18 / $69.45 / $84.33	Professional	26	$55.18	$69.45	$84.33
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $32.29 / $43.99 / $84.39	Professional	TC	$32.29	$43.99	$84.39
United Facility/Professional Professional Modifier Low / Median / High Price $64.20 / $120.88 / $185.42	Professional		$64.20	$120.88	$185.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.08 / $58.08 / $90.96	Professional	26	$34.08	$58.08	$90.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.76 / $57.20 / $114.80	Professional	TC	$31.76	$57.20	$114.80