Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $285.95 / $882.56 / $2,266.33	Facility		$285.95	$882.56	$2,266.33
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.40 / $47.27 / $47.35	Facility	26	$35.40	$47.27	$47.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.85 / $184.55 / $665.00	Professional		$114.85	$184.55	$665.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.03 / $25.55 / $64.03	Professional	26	$21.03	$25.55	$64.03
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $57.43 / $87.09 / $208.80	Professional	52	$57.43	$87.09	$208.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.48 / $157.59 / $282.77	Professional	TC	$111.48	$157.59	$282.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $117.12 / $386.15 / $540.54	Facility		$117.12	$386.15	$540.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.69 / $286.45 / $429.34	Professional		$173.69	$286.45	$429.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.36 / $44.66 / $64.81	Professional	26	$25.36	$44.66	$64.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $148.24 / $243.41 / $371.07	Professional	TC	$148.24	$243.41	$371.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $247.93 / $288.93 / $354.13	Professional		$247.93	$288.93	$354.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.97 / $46.23 / $53.22	Professional	26	$38.97	$46.23	$53.22
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $208.26 / $243.67 / $300.93	Professional	TC	$208.26	$243.67	$300.93
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $134.04 / $249.08 / $374.49	Facility		$134.04	$249.08	$374.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $207.62 / $251.93 / $390.39	Professional		$207.62	$251.93	$390.39
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.63 / $41.58 / $66.84	Professional	26	$33.63	$41.58	$66.84
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $173.99 / $226.99 / $345.88	Professional	TC	$173.99	$226.99	$345.88
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $193.06 / $255.56 / $297.33	Facility		$193.06	$255.56	$297.33
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $31.36 / $40.89 / $42.88	Facility	26	$31.36	$40.89	$42.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.66 / $36.45 / $51.84	Professional	26	$28.66	$36.45	$51.84
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $145.00 / $204.92 / $272.97	Professional	TC	$145.00	$204.92	$272.97
Providence Facility/Professional Facility Modifier Low / Median / High Price $134.59 / $299.47 / $383.94	Facility		$134.59	$299.47	$383.94
Providence Facility/Professional Professional Modifier Low / Median / High Price $236.12 / $290.14 / $375.11	Professional		$236.12	$290.14	$375.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.45 / $45.90 / $60.36	Professional	26	$29.45	$45.90	$60.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $151.04 / $247.16 / $331.27	Professional	TC	$151.04	$247.16	$331.27
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $389.95 / $520.64 / $618.64	Facility		$389.95	$520.64	$618.64
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $459.43 / $459.43 / $459.43	Facility	26	$459.43	$459.43	$459.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $243.14 / $305.18 / $363.84	Professional		$243.14	$305.18	$363.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $39.36 / $49.95 / $60.64	Professional	26	$39.36	$49.95	$60.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $202.62 / $255.22 / $303.20	Professional	TC	$202.62	$255.22	$303.20
United Facility/Professional Professional Modifier Low / Median / High Price $156.41 / $270.41 / $387.39	Professional		$156.41	$270.41	$387.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.97 / $43.61 / $66.31	Professional	26	$24.97	$43.61	$66.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.09 / $223.92 / $322.13	Professional	TC	$123.09	$223.92	$322.13