Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $151.36 / $263.03	Facility	26	$97.72	$151.36	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $446.68 / $1,230.27	Professional		$204.17	$446.68	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $128.82 / $363.08	Professional	26	$69.18	$128.82	$363.08
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $75.86 / $147.91 / $363.08	Professional	52	$75.86	$147.91	$363.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $288.40 / $489.78	Professional	TC	$141.25	$288.40	$489.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $426.58 / $1,000.00	Professional		$208.93	$426.58	$1,000.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $104.71 / $208.93	Professional	26	$64.57	$104.71	$208.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $288.40 / $851.14	Professional	TC	$138.04	$288.40	$851.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $426.58 / $537.03	Professional		$380.19	$426.58	$537.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $147.91 / $177.83	Professional	26	$128.82	$147.91	$177.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $288.40 / $363.08	Professional	TC	$245.47	$288.40	$363.08
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $138.04 / $263.03	Facility	26	$104.71	$138.04	$263.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $467.74 / $851.14	Professional		$323.59	$467.74	$851.14
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $141.25 / $218.78	Professional	26	$85.11	$141.25	$218.78
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $97.72 / $144.54 / $158.49	Professional	52	$97.72	$144.54	$158.49
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $302.00 / $691.83	Professional	TC	$208.93	$302.00	$691.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $138.04 / $141.25	Facility	26	$114.82	$138.04	$141.25
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $218.78	Professional		$213.80	$213.80	$218.78
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $125.89 / $151.36	Professional	26	$85.11	$125.89	$151.36
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $281.84 / $707.95	Professional	TC	$194.98	$281.84	$707.95
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $22.91 / $40.74 / $61.66	Facility	53	$22.91	$40.74	$61.66
Providence Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $457.09 / $831.76	Professional		$223.87	$457.09	$831.76
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $141.25 / $204.17	Professional	26	$69.18	$141.25	$204.17
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $331.13 / $831.76	Professional	TC	$138.04	$331.13	$831.76
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $446.68 / $602.56	Professional		$363.08	$446.68	$602.56
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $147.91 / $190.55	Professional	26	$125.89	$147.91	$190.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $309.03 / $398.11	Professional	TC	$239.88	$309.03	$398.11
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $407.38 / $676.08	Professional		$190.55	$407.38	$676.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $87.10 / $204.17	Professional	26	$64.57	$87.10	$204.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $275.42 / $457.09	Professional	TC	$128.82	$275.42	$457.09