Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.00 / $145.59 / $324.39	Facility	26	$104.00	$145.59	$324.39
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $90.48 / $133.27 / $388.22	Facility	53	$90.48	$133.27	$388.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $210.95 / $475.00 / $1,390.00	Professional		$210.95	$475.00	$1,390.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.59 / $140.00 / $420.03	Professional	26	$70.59	$140.00	$420.03
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $101.81 / $210.19 / $301.50	Professional	52	$101.81	$210.19	$301.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $161.08 / $335.00 / $499.00	Professional	TC	$161.08	$335.00	$499.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $45.11 / $45.11 / $45.11	Facility	53	$45.11	$45.11	$45.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $216.32 / $427.19 / $725.10	Professional		$216.32	$427.19	$725.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.95 / $126.79 / $204.54	Professional	26	$68.95	$126.79	$204.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $145.49 / $291.06 / $551.60	Professional	TC	$145.49	$291.06	$551.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $394.38 / $444.02 / $539.61	Professional		$394.38	$444.02	$539.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $133.09 / $153.88 / $179.04	Professional	26	$133.09	$153.88	$179.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $257.18 / $291.95 / $360.57	Professional	TC	$257.18	$291.95	$360.57
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $328.83 / $454.56 / $814.59	Professional		$328.83	$454.56	$814.59
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $111.01 / $138.02 / $213.48	Professional	26	$111.01	$138.02	$213.48
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $208.15 / $296.45 / $536.85	Professional	TC	$208.15	$296.45	$536.85
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $103.39 / $137.19 / $141.37	Facility	26	$103.39	$137.19	$141.37
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $160.34 / $160.34	Professional		$160.34	$160.34	$160.34
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $84.80 / $123.22 / $147.19	Professional	26	$84.80	$123.22	$147.19
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $177.20 / $279.39 / $760.38	Professional	TC	$177.20	$279.39	$760.38
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $45.11 / $45.11 / $45.11	Facility	53	$45.11	$45.11	$45.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $330.53 / $478.14 / $624.66	Professional		$330.53	$478.14	$624.66
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $72.33 / $126.79 / $204.54	Professional	26	$72.33	$126.79	$204.54
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $237.36 / $237.36 / $237.95	Professional	52	$237.36	$237.36	$237.95
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $145.49 / $291.06 / $548.48	Professional	TC	$145.49	$291.06	$548.48
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $782.93 / $782.93 / $782.93	Facility	26	$782.93	$782.93	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $365.68 / $479.51 / $689.45	Professional		$365.68	$479.51	$689.45
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $125.69 / $149.28 / $198.98	Professional	26	$125.69	$149.28	$198.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $240.00 / $312.08 / $452.49	Professional	TC	$240.00	$312.08	$452.49
United Facility/Professional Professional Modifier Low / Median / High Price $192.64 / $376.80 / $650.04	Professional		$192.64	$376.80	$650.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.14 / $92.14 / $218.09	Professional	26	$64.14	$92.14	$218.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $127.91 / $244.51 / $443.71	Professional	TC	$127.91	$244.51	$443.71