Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.14 / $92.15 / $136.50	Facility	26	$58.14	$92.15	$136.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $99.63 / $189.35 / $628.28	Professional		$99.63	$189.35	$628.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.75 / $66.15 / $237.80	Professional	26	$44.75	$66.15	$237.80
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $44.73 / $67.17 / $314.14	Professional	52	$44.73	$67.17	$314.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.07 / $126.14 / $242.00	Professional	TC	$51.07	$126.14	$242.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.80 / $49.80 / $49.80	Facility	26	$49.80	$49.80	$49.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.09 / $252.82 / $385.70	Professional		$158.09	$252.82	$385.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.16 / $103.28 / $144.60	Professional	26	$66.16	$103.28	$144.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.78 / $144.40 / $241.63	Professional	TC	$87.78	$144.40	$241.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $172.15 / $224.47 / $257.99	Professional		$172.15	$224.47	$257.99
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.01 / $98.95 / $111.41	Professional	26	$76.01	$98.95	$111.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $96.13 / $124.87 / $146.58	Professional	TC	$96.13	$124.87	$146.58
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $153.71 / $235.84 / $341.62	Professional		$153.71	$235.84	$341.62
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $68.84 / $93.89 / $140.74	Professional	26	$68.84	$93.89	$140.74
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $73.03 / $106.91 / $187.92	Professional	TC	$73.03	$106.91	$187.92
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $70.91 / $85.76 / $116.58	Facility	26	$70.91	$85.76	$116.58
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $60.31 / $87.44 / $130.50	Professional	26	$60.31	$87.44	$130.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $75.03 / $154.50 / $220.43	Professional	TC	$75.03	$154.50	$220.43
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $49.80 / $49.80 / $49.80	Facility	26	$49.80	$49.80	$49.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $135.22 / $217.89 / $326.07	Professional		$135.22	$217.89	$326.07
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $73.31 / $104.36 / $148.75	Professional	26	$73.31	$104.36	$148.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $104.95 / $144.40 / $249.44	Professional	TC	$104.95	$144.40	$249.44
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 $147.96 / $202.87 / $313.95	Professional		$147.96	$202.87	$313.95
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $69.66 / $95.51 / $122.23	Professional	26	$69.66	$95.51	$122.23
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $78.30 / $110.29 / $176.64	Professional	TC	$78.30	$110.29	$176.64
United Facility/Professional Professional Modifier Low / Median / High Price $153.47 / $246.71 / $346.32	Professional		$153.47	$246.71	$346.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.12 / $108.04 / $138.02	Professional	26	$69.12	$108.04	$138.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.09 / $151.68 / $217.86	Professional	TC	$109.09	$151.68	$217.86