Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.25 / $74.86 / $110.62	Facility	26	$58.25	$74.86	$110.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.89 / $213.48 / $694.00	Professional		$84.89	$213.48	$694.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.82 / $58.60 / $244.17	Professional	26	$43.82	$58.60	$244.17
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $172.62 / $192.50 / $325.39	Professional	50	$172.62	$192.50	$325.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.17 / $52.38 / $109.17	Professional	TC	$40.17	$52.38	$109.17
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.51 / $50.51 / $50.51	Facility	26	$50.51	$50.51	$50.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.93 / $201.61 / $279.99	Professional		$112.93	$201.61	$279.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.77 / $93.55 / $127.74	Professional	26	$61.77	$93.55	$127.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.85 / $108.83 / $153.41	Professional	TC	$53.85	$108.83	$153.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $167.72 / $218.68 / $251.81	Professional		$167.72	$218.68	$251.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $78.56 / $102.44 / $115.66	Professional	26	$78.56	$102.44	$115.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $115.94 / $136.16	Professional	TC	$89.13	$115.94	$136.16
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $135.86 / $166.40 / $295.83	Professional		$135.86	$166.40	$295.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.98 / $86.04 / $141.11	Professional	26	$70.98	$86.04	$141.11
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $78.45 / $95.10 / $155.96	Professional	TC	$78.45	$95.10	$155.96
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $63.95 / $87.77 / $89.11	Facility	26	$63.95	$87.77	$89.11
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $53.06 / $68.27 / $91.08	Professional	26	$53.06	$68.27	$91.08
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $52.92 / $80.84 / $99.54	Professional	TC	$52.92	$80.84	$99.54
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $50.51 / $50.51 / $50.51	Facility	26	$50.51	$50.51	$50.51
Providence Facility/Professional Professional Modifier Low / Median / High Price $131.76 / $205.11 / $267.77	Professional		$131.76	$205.11	$267.77
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $60.25 / $95.50 / $127.74	Professional	26	$60.25	$95.50	$127.74
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $53.85 / $111.77 / $153.41	Professional	TC	$53.85	$111.77	$153.41
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $153.13 / $193.95 / $275.72	Professional		$153.13	$193.95	$275.72
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $68.23 / $88.64 / $126.02	Professional	26	$68.23	$88.64	$126.02
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $81.05 / $105.31 / $149.71	Professional	TC	$81.05	$105.31	$149.71
United Facility/Professional Professional Modifier Low / Median / High Price $148.12 / $193.13 / $309.58	Professional		$148.12	$193.13	$309.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.13 / $98.45 / $141.28	Professional	26	$68.13	$98.45	$141.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.44 / $95.04 / $155.29	Professional	TC	$73.44	$95.04	$155.29