Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $93.33 / $169.82	Facility	26	$64.57	$93.33	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $199.53 / $645.65	Professional		$112.20	$199.53	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $52.48 / $147.91	Professional	26	$37.15	$52.48	$147.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $144.54 / $263.03	Professional	TC	$69.18	$144.54	$263.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $199.53 / $398.11	Professional		$112.20	$199.53	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $58.88 / $120.23	Professional	26	$38.02	$58.88	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $141.25 / $302.00	Professional	TC	$72.44	$141.25	$302.00
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $81.28 / $81.28	Professional	26	$81.28	$81.28	$81.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $234.42 / $295.12	Professional		$204.17	$234.42	$295.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $85.11 / $102.33	Professional	26	$74.13	$85.11	$102.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $147.91 / $190.55	Professional	TC	$128.82	$147.91	$190.55
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $93.33 / $169.82	Facility	26	$69.18	$93.33	$169.82
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $239.88 / $389.05	Professional		$177.83	$239.88	$389.05
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $77.62 / $125.89	Professional	26	$39.81	$77.62	$125.89
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $154.88 / $302.00	Professional	TC	$91.20	$154.88	$302.00
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $79.43 / $81.28	Facility	26	$66.07	$79.43	$81.28
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $72.44 / $89.13	Professional	26	$47.86	$72.44	$89.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $138.04 / $263.03	Professional	TC	$91.20	$138.04	$263.03
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $45.71 / $66.07	Facility	26	$9.77	$45.71	$66.07
Providence Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $239.88 / $363.08	Professional		$117.49	$239.88	$363.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $83.18 / $117.49	Professional	26	$39.81	$83.18	$117.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $162.18 / $295.12	Professional	TC	$72.44	$162.18	$295.12
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $234.42 / $309.03	Professional		$194.98	$234.42	$309.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $85.11 / $109.65	Professional	26	$72.44	$85.11	$109.65
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $147.91 / $204.17	Professional	TC	$125.89	$147.91	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $194.98 / $346.74	Professional		$100.00	$194.98	$346.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $51.29 / $114.82	Professional	26	$37.15	$51.29	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $131.83 / $223.87	Professional	TC	$63.10	$131.83	$223.87