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 / $326.10	Facility	26	$104.00	$145.59	$326.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.99 / $475.00 / $1,266.70	Professional		$208.99	$475.00	$1,266.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.03 / $140.00 / $372.40	Professional	26	$71.03	$140.00	$372.40
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $99.66 / $237.50 / $628.48	Professional	52	$99.66	$237.50	$628.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $136.80 / $335.00 / $613.76	Professional	TC	$136.80	$335.00	$613.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.59 / $80.59 / $80.59	Facility	26	$80.59	$80.59	$80.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $210.81 / $418.61 / $700.00	Professional		$210.81	$418.61	$700.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.31 / $126.79 / $205.53	Professional	26	$69.31	$126.79	$205.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $139.61 / $280.30 / $517.51	Professional	TC	$139.61	$280.30	$517.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $383.80 / $434.66 / $524.78	Professional		$383.80	$434.66	$524.78
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 $245.95 / $280.07 / $344.81	Professional	TC	$245.95	$280.07	$344.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $320.04 / $442.41 / $740.33	Professional		$320.04	$442.41	$740.33
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $111.54 / $138.02 / $213.48	Professional	26	$111.54	$138.02	$213.48
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $199.07 / $283.52 / $810.96	Professional	TC	$199.07	$283.52	$810.96
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $103.88 / $137.85 / $142.71	Facility	26	$103.88	$137.85	$142.71
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $257.83 / $257.83	Professional		$160.34	$257.83	$257.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $84.80 / $128.61 / $160.65	Professional	26	$84.80	$128.61	$160.65
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $169.34 / $268.67 / $522.45	Professional	TC	$169.34	$268.67	$522.45
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $80.59 / $80.59 / $80.59	Facility	26	$80.59	$80.59	$80.59
Providence Facility/Professional Professional Modifier Low / Median / High Price $322.39 / $468.00 / $609.17	Professional		$322.39	$468.00	$609.17
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $72.53 / $127.65 / $205.53	Professional	26	$72.53	$127.65	$205.53
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $232.32 / $232.32 / $232.32	Professional	52	$232.32	$232.32	$232.32
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $139.61 / $278.89 / $500.79	Professional	TC	$139.61	$278.89	$500.79
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 $356.71 / $467.97 / $672.53	Professional		$356.71	$467.97	$672.53
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 $231.02 / $303.36 / $435.56	Professional	TC	$231.02	$303.36	$435.56
United Facility/Professional Professional Modifier Low / Median / High Price $187.74 / $363.39 / $634.09	Professional		$187.74	$363.39	$634.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.45 / $93.43 / $217.55	Professional	26	$64.45	$93.43	$217.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.01 / $208.52 / $414.48	Professional	TC	$123.01	$208.52	$414.48