Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $151.36 / $269.15	Facility	26	$104.71	$151.36	$269.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $478.63 / $1,230.27	Professional		$208.93	$478.63	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $141.25 / $331.13	Professional	26	$69.18	$141.25	$331.13
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $234.42 / $234.42 / $234.42	Professional	52	$234.42	$234.42	$234.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $263.03 / $501.19	Professional	TC	$131.83	$263.03	$501.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $398.11 / $891.25	Professional		$199.53	$398.11	$891.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $107.15 / $218.78	Professional	26	$66.07	$107.15	$218.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $275.42 / $758.58	Professional	TC	$131.83	$275.42	$758.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $416.87 / $524.81	Professional		$371.54	$416.87	$524.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $147.91 / $181.97	Professional	26	$128.82	$147.91	$181.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $275.42 / $346.74	Professional	TC	$239.88	$275.42	$346.74
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $141.25 / $323.59	Facility	26	$104.71	$141.25	$323.59
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $457.09 / $870.96	Professional		$316.23	$457.09	$870.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $144.54 / $218.78	Professional	26	$93.33	$144.54	$218.78
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $123.03 / $331.13 / $1,698.24	Professional	52	$123.03	$331.13	$1,698.24
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $288.40 / $691.83	Professional	TC	$204.17	$288.40	$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 26 Low / Median / High Price $89.13 / $128.82 / $158.49	Professional	26	$89.13	$128.82	$158.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $281.84 / $676.08	Professional	TC	$190.55	$281.84	$676.08
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 Professional Modifier Low / Median / High Price $213.80 / $457.09 / $758.58	Professional		$213.80	$457.09	$758.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $147.91 / $208.93	Professional	26	$69.18	$147.91	$208.93
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $316.23 / $741.31	Professional	TC	$131.83	$316.23	$741.31
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 $354.81 / $436.52 / $588.84	Professional		$354.81	$436.52	$588.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $151.36 / $190.55	Professional	26	$125.89	$151.36	$190.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $295.12 / $389.05	Professional	TC	$229.09	$295.12	$389.05
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $398.11 / $645.65	Professional		$186.21	$398.11	$645.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $93.33 / $204.17	Professional	26	$64.57	$93.33	$204.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $263.03 / $436.52	Professional	TC	$123.03	$263.03	$436.52