Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $324.22 / $494.80 / $798.00	Facility		$324.22	$494.80	$798.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.06 / $90.03 / $111.15	Facility	26	$75.06	$90.03	$111.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $155.44 / $227.64 / $880.00	Professional		$155.44	$227.64	$880.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.55 / $61.49 / $219.07	Professional	26	$41.55	$61.49	$219.07
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $124.36 / $127.29 / $223.85	Professional	52	$124.36	$127.29	$223.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.32 / $163.53 / $250.59	Professional	TC	$111.32	$163.53	$250.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $250.00 / $250.00 / $250.00	Facility		$250.00	$250.00	$250.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.86 / $44.86 / $44.86	Facility	26	$44.86	$44.86	$44.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $214.53 / $333.29 / $459.73	Professional		$214.53	$333.29	$459.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.59 / $90.29 / $119.32	Professional	26	$59.59	$90.29	$119.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $153.53 / $243.17 / $349.40	Professional	TC	$153.53	$243.17	$349.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $231.11 / $301.33 / $348.47	Professional		$231.11	$301.33	$348.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.68 / $87.97 / $99.05	Professional	26	$67.68	$87.97	$99.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $163.44 / $212.42 / $252.16	Professional	TC	$163.44	$212.42	$252.16
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $151.31 / $236.64 / $443.70	Facility		$151.31	$236.64	$443.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $205.47 / $292.32 / $408.46	Professional		$205.47	$292.32	$408.46
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.38 / $74.40 / $122.02	Professional	26	$61.38	$74.40	$122.02
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.01 / $174.68 / $286.48	Professional	TC	$131.01	$174.68	$286.48
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $211.69 / $273.36 / $337.68	Facility		$211.69	$273.36	$337.68
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $63.21 / $77.72 / $99.16	Facility	26	$63.21	$77.72	$99.16
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $59.09 / $79.50 / $102.12	Professional	26	$59.09	$79.50	$102.12
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $143.37 / $201.78 / $254.76	Professional	TC	$143.37	$201.78	$254.76
Providence Facility/Professional Facility Modifier Low / Median / High Price $152.75 / $270.44 / $443.70	Facility		$152.75	$270.44	$443.70
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $44.86 / $44.86 / $44.86	Facility	26	$44.86	$44.86	$44.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $209.15 / $335.30 / $436.10	Professional		$209.15	$335.30	$436.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $61.43 / $90.57 / $119.32	Professional	26	$61.43	$90.57	$119.32
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $160.36 / $252.27 / $350.14	Professional	TC	$160.36	$252.27	$350.14
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $389.95 / $496.95 / $618.64	Facility		$389.95	$496.95	$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 $240.30 / $320.66 / $427.99	Professional		$240.30	$320.66	$427.99
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.26 / $84.70 / $112.75	Professional	26	$64.26	$84.70	$112.75
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $176.04 / $232.76 / $308.89	Professional	TC	$176.04	$232.76	$308.89
United Facility/Professional Professional Modifier Low / Median / High Price $243.36 / $336.96 / $473.44	Professional		$243.36	$336.96	$473.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.58 / $93.62 / $126.62	Professional	26	$60.58	$93.62	$126.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $179.84 / $244.99 / $346.82	Professional	TC	$179.84	$244.99	$346.82