Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $295.12 / $323.59	Facility	26	$169.82	$295.12	$323.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $275.42 / $676.08	Professional		$204.17	$275.42	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $144.54 / $380.19	Professional	26	$120.23	$144.54	$380.19
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $616.60 / $616.60 / $616.60	Professional	50	$616.60	$616.60	$616.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $97.72 / $169.82	Professional	TC	$77.62	$97.72	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $416.87 / $616.60	Professional		$245.47	$416.87	$616.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $245.47 / $371.54	Professional	26	$144.54	$245.47	$371.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $169.82 / $263.03	Professional	TC	$93.33	$169.82	$263.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $478.63 / $562.34	Professional		$398.11	$478.63	$562.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $234.42 / $288.40 / $338.84	Professional	26	$234.42	$288.40	$338.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $199.53 / $223.87	Professional	TC	$158.49	$199.53	$223.87
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $218.78 / $218.78	Facility	26	$169.82	$218.78	$218.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $407.38 / $562.34	Professional		$245.47	$407.38	$562.34
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $263.03 / $380.19	Professional	26	$131.83	$263.03	$380.19
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $616.60 / $616.60 / $616.60	Professional	50	$616.60	$616.60	$616.60
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $169.82 / $234.42	Professional	TC	$93.33	$169.82	$234.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $257.04 / $257.04	Facility	26	$213.80	$257.04	$257.04
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $275.42	Professional		$275.42	$275.42	$275.42
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $213.80 / $269.15	Professional	26	$169.82	$213.80	$269.15
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $151.36 / $194.98	Professional	TC	$114.82	$151.36	$194.98
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $147.91 / $208.93	Facility	26	$31.62	$147.91	$208.93
Providence Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $446.68 / $602.56	Professional		$309.03	$446.68	$602.56
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $257.04 / $371.54	Professional	26	$162.18	$257.04	$371.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $177.83 / $251.19	Professional	TC	$117.49	$177.83	$251.19
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,513.56 / $1,513.56 / $1,513.56	Facility	26	$1,513.56	$1,513.56	$1,513.56
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $446.68 / $575.44	Professional		$338.84	$446.68	$575.44
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $208.93 / $257.04 / $346.74	Professional	26	$208.93	$257.04	$346.74
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $181.97 / $223.87	Professional	TC	$134.90	$181.97	$223.87
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $446.68 / $660.69	Professional		$269.15	$446.68	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $263.03 / $389.05	Professional	26	$165.96	$263.03	$389.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $186.21 / $263.03	Professional	TC	$107.15	$186.21	$263.03