Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.00 / $120.84 / $246.40	Facility	26	$86.00	$120.84	$246.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $158.55 / $321.13 / $664.08	Professional		$158.55	$321.13	$664.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.43 / $82.56 / $270.01	Professional	26	$53.43	$82.56	$270.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.69 / $261.63 / $379.60	Professional	TC	$102.69	$261.63	$379.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.98 / $60.98 / $60.98	Facility	26	$60.98	$60.98	$60.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $167.34 / $309.55 / $499.15	Professional		$167.34	$309.55	$499.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.77 / $95.79 / $155.37	Professional	26	$52.77	$95.79	$155.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $113.54 / $212.36 / $371.78	Professional	TC	$113.54	$212.36	$371.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $305.31 / $342.38 / $417.89	Professional		$305.31	$342.38	$417.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $101.82 / $117.21 / $137.00	Professional	26	$101.82	$117.21	$137.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $200.36 / $227.44 / $280.89	Professional	TC	$200.36	$227.44	$280.89
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $254.59 / $351.94 / $509.02	Professional		$254.59	$351.94	$509.02
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.86 / $113.40 / $162.66	Professional	26	$84.86	$113.40	$162.66
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $162.24 / $231.08 / $369.52	Professional	TC	$162.24	$231.08	$369.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $78.89 / $104.95 / $120.25	Facility	26	$78.89	$104.95	$120.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $64.72 / $95.50 / $121.18	Professional	26	$64.72	$95.50	$121.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $125.60 / $209.44 / $370.44	Professional	TC	$125.60	$209.44	$370.44
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $60.98 / $60.98 / $60.98	Facility	26	$60.98	$60.98	$60.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $252.59 / $372.06 / $479.70	Professional		$252.59	$372.06	$479.70
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $53.80 / $97.83 / $155.37	Professional	26	$53.80	$97.83	$155.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $113.54 / $211.31 / $371.78	Professional	TC	$113.54	$211.31	$371.78
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 $282.49 / $370.71 / $499.82	Professional		$282.49	$370.71	$499.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.76 / $114.39 / $151.60	Professional	26	$95.76	$114.39	$151.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $186.73 / $245.04 / $352.06	Professional	TC	$186.73	$245.04	$352.06
United Facility/Professional Professional Modifier Low / Median / High Price $144.18 / $250.06 / $489.00	Professional		$144.18	$250.06	$489.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.08 / $78.79 / $165.37	Professional	26	$49.08	$78.79	$165.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.10 / $195.97 / $328.85	Professional	TC	$95.10	$195.97	$328.85