Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.00 / $115.47 / $252.70	Facility	26	$86.00	$115.47	$252.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.97 / $247.94 / $687.35	Professional		$118.97	$247.94	$687.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.89 / $62.14 / $189.00	Professional	26	$46.89	$62.14	$189.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $60.85 / $123.97 / $199.60	Professional	52	$60.85	$123.97	$199.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.28 / $207.11 / $415.73	Professional	TC	$89.28	$207.11	$415.73
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $145.97 / $283.20 / $448.09	Professional		$145.97	$283.20	$448.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.52 / $96.75 / $141.16	Professional	26	$50.52	$96.75	$141.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $94.22 / $187.55 / $308.51	Professional	TC	$94.22	$187.55	$308.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $267.18 / $298.38 / $364.90	Professional		$267.18	$298.38	$364.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $97.28 / $112.18 / $130.90	Professional	26	$97.28	$112.18	$130.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $166.91 / $189.47 / $234.00	Professional	TC	$166.91	$189.47	$234.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $222.70 / $300.00 / $443.52	Professional		$222.70	$300.00	$443.52
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.13 / $105.60 / $155.55	Professional	26	$81.13	$105.60	$155.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $135.04 / $192.32 / $383.16	Professional	TC	$135.04	$192.32	$383.16
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $71.54 / $99.41 / $107.42	Facility	26	$71.54	$99.41	$107.42
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $78.25 / $78.25	Professional		$78.25	$78.25	$78.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $67.50 / $96.44 / $114.92	Professional	26	$67.50	$96.44	$114.92
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $152.88 / $232.96 / $359.12	Professional	TC	$152.88	$232.96	$359.12
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $221.78 / $329.30 / $418.52	Professional		$221.78	$329.30	$418.52
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $52.60 / $98.31 / $149.47	Professional	26	$52.60	$98.31	$149.47
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $157.38 / $159.13 / $159.13	Professional	52	$157.38	$159.13	$159.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $95.09 / $187.55 / $306.77	Professional	TC	$95.09	$187.55	$306.77
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 $247.18 / $329.91 / $422.73	Professional		$247.18	$329.91	$422.73
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $89.67 / $111.26 / $144.97	Professional	26	$89.67	$111.26	$144.97
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $155.61 / $207.90 / $294.02	Professional	TC	$155.61	$207.90	$294.02
United Facility/Professional Professional Modifier Low / Median / High Price $136.51 / $251.91 / $459.96	Professional		$136.51	$251.91	$459.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.29 / $59.82 / $162.79	Professional	26	$44.29	$59.82	$162.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.20 / $156.96 / $290.44	Professional	TC	$86.20	$156.96	$290.44