Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.54 / $99.45 / $200.92	Facility	26	$69.54	$99.45	$200.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.66 / $199.54 / $650.00	Professional		$104.66	$199.54	$650.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.83 / $54.10 / $148.91	Professional	26	$37.83	$54.10	$148.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.29 / $167.19 / $397.86	Professional	TC	$72.29	$167.19	$397.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.92 / $45.92 / $45.92	Facility	26	$45.92	$45.92	$45.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $116.46 / $215.49 / $359.85	Professional		$116.46	$215.49	$359.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.79 / $72.38 / $117.02	Professional	26	$39.79	$72.38	$117.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $140.41 / $247.76	Professional	TC	$75.86	$140.41	$247.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $214.34 / $239.37 / $292.88	Professional		$214.34	$239.37	$292.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.78 / $88.39 / $103.33	Professional	26	$76.78	$88.39	$103.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $135.19 / $153.47 / $189.55	Professional	TC	$135.19	$153.47	$189.55
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $173.46 / $246.50 / $346.88	Professional		$173.46	$246.50	$346.88
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.05 / $79.73 / $121.98	Professional	26	$64.05	$79.73	$121.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.41 / $155.83 / $303.18	Professional	TC	$109.41	$155.83	$303.18
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $59.78 / $79.15 / $81.73	Facility	26	$59.78	$79.15	$81.73
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $55.80 / $71.92 / $84.42	Professional	26	$55.80	$71.92	$84.42
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $96.61 / $138.02 / $265.06	Professional	TC	$96.61	$138.02	$265.06
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $45.92 / $45.92 / $45.92	Facility	26	$45.92	$45.92	$45.92
Providence Facility/Professional Professional Modifier Low / Median / High Price $176.04 / $252.14 / $322.42	Professional		$176.04	$252.14	$322.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.18 / $72.40 / $117.02	Professional	26	$41.18	$72.40	$117.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $139.24 / $246.82	Professional	TC	$75.86	$139.24	$246.82
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 Professional Modifier Low / Median / High Price $196.91 / $256.04 / $312.02	Professional		$196.91	$256.04	$312.02
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $71.81 / $85.61 / $113.70	Professional	26	$71.81	$85.61	$113.70
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $125.09 / $160.74 / $226.92	Professional	TC	$125.09	$160.74	$226.92
United Facility/Professional Professional Modifier Low / Median / High Price $99.70 / $155.58 / $346.77	Professional		$99.70	$155.58	$346.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.96 / $53.65 / $124.31	Professional	26	$36.96	$53.65	$124.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.58 / $122.40 / $232.01	Professional	TC	$62.58	$122.40	$232.01