Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.00 / $151.81 / $324.39	Facility	26	$104.00	$151.81	$324.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.72 / $475.00 / $1,254.92	Professional		$199.72	$475.00	$1,254.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.95 / $140.00 / $322.00	Professional	26	$70.95	$140.00	$322.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $99.49 / $237.50 / $396.07	Professional	52	$99.49	$237.50	$396.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $108.85 / $305.00 / $507.50	Professional	TC	$108.85	$305.00	$507.50
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 Professional Modifier Low / Median / High Price $210.08 / $417.92 / $693.72	Professional		$210.08	$417.92	$693.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.31 / $126.79 / $204.54	Professional	26	$69.31	$126.79	$204.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $139.24 / $277.39 / $516.94	Professional	TC	$139.24	$277.39	$516.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $382.47 / $433.93 / $522.94	Professional		$382.47	$433.93	$522.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $133.72 / $154.61 / $179.97	Professional	26	$133.72	$154.61	$179.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $244.62 / $279.35 / $342.97	Professional	TC	$244.62	$279.35	$342.97
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $309.56 / $440.88 / $737.82	Professional		$309.56	$440.88	$737.82
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $111.54 / $145.86 / $213.48	Professional	26	$111.54	$145.86	$213.48
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $198.02 / $282.02 / $730.98	Professional	TC	$198.02	$282.02	$730.98
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $103.88 / $137.85 / $142.80	Facility	26	$103.88	$137.85	$142.80
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $265.92 / $302.39	Professional		$160.34	$265.92	$302.39
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $85.22 / $135.68 / $157.91	Professional	26	$85.22	$135.68	$157.91
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $177.24 / $282.74 / $721.02	Professional	TC	$177.24	$282.74	$721.02
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 Professional Modifier Low / Median / High Price $321.29 / $467.22 / $607.11	Professional		$321.29	$467.22	$607.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $72.53 / $128.81 / $206.06	Professional	26	$72.53	$128.81	$206.06
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $231.94 / $231.94 / $231.94	Professional	52	$231.94	$231.94	$231.94
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $139.24 / $275.95 / $495.75	Professional	TC	$139.24	$275.95	$495.75
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 $355.51 / $466.44 / $670.27	Professional		$355.51	$466.44	$670.27
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $125.69 / $149.99 / $198.98	Professional	26	$125.69	$149.99	$198.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $229.82 / $303.36 / $433.31	Professional	TC	$229.82	$303.36	$433.31
United Facility/Professional Professional Modifier Low / Median / High Price $187.43 / $366.60 / $631.53	Professional		$187.43	$366.60	$631.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.52 / $94.07 / $217.55	Professional	26	$64.52	$94.07	$217.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $122.70 / $240.00 / $424.18	Professional	TC	$122.70	$240.00	$424.18