Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $121.02 / $268.08	Facility	26	$105.78	$121.02	$268.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $146.25 / $265.33 / $722.66	Professional		$146.25	$265.33	$722.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.57 / $69.08 / $247.77	Professional	26	$48.57	$69.08	$247.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.46 / $208.44 / $354.57	Professional	TC	$96.46	$208.44	$354.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.34 / $61.34 / $61.34	Facility	26	$61.34	$61.34	$61.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $163.07 / $289.67 / $457.00	Professional		$163.07	$289.67	$457.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.95 / $96.87 / $156.36	Professional	26	$51.95	$96.87	$156.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $108.91 / $195.32 / $336.53	Professional	TC	$108.91	$195.32	$336.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $298.04 / $333.75 / $407.72	Professional		$298.04	$333.75	$407.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $101.82 / $117.43 / $137.00	Professional	26	$101.82	$117.43	$137.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $193.11 / $219.20 / $270.70	Professional	TC	$193.11	$219.20	$270.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $248.56 / $323.00 / $479.57	Professional		$248.56	$323.00	$479.57
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.86 / $110.37 / $168.69	Professional	26	$84.86	$110.37	$168.69
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $156.38 / $222.73 / $369.52	Professional	TC	$156.38	$222.73	$369.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $78.89 / $104.95 / $107.87	Facility	26	$78.89	$104.95	$107.87
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $155.88	Professional		$140.29	$140.29	$155.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $68.20 / $91.20 / $118.34	Professional	26	$68.20	$91.20	$118.34
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $139.29 / $196.31 / $325.62	Professional	TC	$139.29	$196.31	$325.62
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $61.34 / $61.34 / $61.34	Facility	26	$61.34	$61.34	$61.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $245.70 / $350.36 / $448.11	Professional		$245.70	$350.36	$448.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $54.16 / $96.87 / $156.36	Professional	26	$54.16	$96.87	$156.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $108.91 / $193.28 / $336.53	Professional	TC	$108.91	$193.28	$336.53
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.78 / $851.78 / $851.78	Facility	26	$851.78	$851.78	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $274.70 / $360.50 / $435.42	Professional		$274.70	$360.50	$435.42
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.76 / $114.62 / $151.60	Professional	26	$95.76	$114.62	$151.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $178.95 / $230.62 / $298.89	Professional	TC	$178.95	$230.62	$298.89
United Facility/Professional Professional Modifier Low / Median / High Price $139.71 / $221.60 / $475.52	Professional		$139.71	$221.60	$475.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.08 / $63.52 / $165.11	Professional	26	$49.08	$63.52	$165.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.60 / $142.82 / $309.76	Professional	TC	$90.60	$142.82	$309.76