Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $157.75 / $426.23 / $759.36	Facility		$157.75	$426.23	$759.36
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.17 / $68.88 / $142.50	Facility	26	$48.17	$68.88	$142.50
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $109.56 / $188.55 / $836.00	Facility	TC	$109.56	$188.55	$836.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $110.29 / $149.51 / $587.92	Professional		$110.29	$149.51	$587.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.67 / $50.64 / $163.11	Professional	26	$31.67	$50.64	$163.11
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $35.94 / $66.59 / $174.30	Professional	52	$35.94	$66.59	$174.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.09 / $104.87 / $210.77	Professional	TC	$76.09	$104.87	$210.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $81.68 / $301.52 / $367.38	Facility		$81.68	$301.52	$367.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $129.04 / $241.55 / $332.32	Professional		$129.04	$241.55	$332.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.90 / $72.27 / $102.27	Professional	26	$39.90	$72.27	$102.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $88.93 / $165.72 / $218.26	Professional	TC	$88.93	$165.72	$218.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $206.35 / $240.48 / $291.51	Professional		$206.35	$240.48	$291.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $65.42 / $77.42 / $89.34	Professional	26	$65.42	$77.42	$89.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $139.91 / $163.69 / $202.17	Professional	TC	$139.91	$163.69	$202.17
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $111.05 / $205.92 / $324.00	Facility		$111.05	$205.92	$324.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $172.39 / $197.50 / $332.43	Professional		$172.39	$197.50	$332.43
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.51 / $67.95 / $110.34	Professional	26	$55.51	$67.95	$110.34
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $116.89 / $153.40 / $232.36	Professional	TC	$116.89	$153.40	$232.36
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $156.01 / $212.70 / $247.65	Facility		$156.01	$212.70	$247.65
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $51.45 / $68.48 / $70.34	Facility	26	$51.45	$68.48	$70.34
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $120.43 / $144.22 / $168.33	Facility	TC	$120.43	$144.22	$168.33
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $86.94 / $86.94	Professional		$78.25	$86.94	$86.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $42.21 / $59.85 / $75.59	Professional	26	$42.21	$59.85	$75.59
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $100.10 / $133.60 / $181.57	Professional	TC	$100.10	$133.60	$181.57
Providence Facility/Professional Facility Modifier Low / Median / High Price $124.15 / $266.80 / $339.16	Facility		$124.15	$266.80	$339.16
Providence Facility/Professional Professional Modifier Low / Median / High Price $193.98 / $248.16 / $317.19	Professional		$193.98	$248.16	$317.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.35 / $75.88 / $102.27	Professional	26	$46.35	$75.88	$102.27
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $124.25 / $124.25 / $126.62	Professional	52	$124.25	$124.25	$126.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $101.02 / $172.75 / $221.04	Professional	TC	$101.02	$172.75	$221.04
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $312.19 / $372.00 / $463.05	Facility		$312.19	$372.00	$463.05
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 Facility Modifier TC Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	TC	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $198.65 / $260.58 / $309.83	Professional		$198.65	$260.58	$309.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $63.70 / $83.48 / $98.54	Professional	26	$63.70	$83.48	$98.54
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $138.41 / $179.00 / $211.29	Professional	TC	$138.41	$179.00	$211.29
United Facility/Professional Professional Modifier Low / Median / High Price $114.63 / $138.31 / $344.65	Professional		$114.63	$138.31	$344.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.36 / $41.37 / $107.49	Professional	26	$37.36	$41.37	$107.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.26 / $97.08 / $231.88	Professional	TC	$77.26	$97.08	$231.88