Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.28 / $100.29 / $202.75	Facility	26	$80.28	$100.29	$202.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $139.78 / $269.92 / $784.76	Professional		$139.78	$269.92	$784.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.72 / $72.73 / $193.00	Professional	26	$40.72	$72.73	$193.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $58.54 / $126.60 / $198.49	Professional	52	$58.54	$126.60	$198.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.93 / $207.11 / $379.20	Professional	TC	$94.93	$207.11	$379.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.27 / $46.27 / $46.27	Facility	26	$46.27	$46.27	$46.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.41 / $259.86 / $437.00	Professional		$141.41	$259.86	$437.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.96 / $74.55 / $118.01	Professional	26	$40.96	$74.55	$118.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.46 / $184.57 / $310.43	Professional	TC	$100.46	$184.57	$310.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $257.30 / $287.33 / $353.09	Professional		$257.30	$287.33	$353.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $77.43 / $89.13 / $104.27	Professional	26	$77.43	$89.13	$104.27
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $177.47 / $201.48 / $248.83	Professional	TC	$177.47	$201.48	$248.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $208.15 / $299.25 / $430.92	Professional		$208.15	$299.25	$430.92
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.58 / $91.98 / $123.00	Professional	26	$64.58	$91.98	$123.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $143.57 / $204.47 / $308.14	Professional	TC	$143.57	$204.47	$308.14
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $63.44 / $79.81 / $105.30	Facility	26	$63.44	$79.81	$105.30
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $86.94 / $86.94 / $91.43	Professional		$86.94	$86.94	$91.43
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $51.24 / $81.00 / $103.85	Professional	26	$51.24	$81.00	$103.85
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $113.82 / $186.99 / $304.00	Professional	TC	$113.82	$186.99	$304.00
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $46.27 / $46.27 / $46.27	Facility	26	$46.27	$46.27	$46.27
Providence Facility/Professional Professional Modifier Low / Median / High Price $211.68 / $310.91 / $403.85	Professional		$211.68	$310.91	$403.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.53 / $74.66 / $120.00	Professional	26	$41.53	$74.66	$120.00
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $151.72 / $153.33 / $153.33	Professional	52	$151.72	$153.33	$153.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $100.46 / $183.02 / $316.67	Professional	TC	$100.46	$183.02	$316.67
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 $238.20 / $312.58 / $418.20	Professional		$238.20	$312.58	$418.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $72.42 / $95.23 / $114.65	Professional	26	$72.42	$95.23	$114.65
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $165.78 / $217.56 / $312.57	Professional	TC	$165.78	$217.56	$312.57
United Facility/Professional Professional Modifier Low / Median / High Price $119.73 / $207.42 / $412.32	Professional		$119.73	$207.42	$412.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.21 / $54.15 / $125.35	Professional	26	$37.21	$54.15	$125.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.77 / $158.36 / $286.97	Professional	TC	$82.77	$158.36	$286.97