Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.00 / $137.60 / $303.39	Facility	26	$86.00	$137.60	$303.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $152.38 / $268.39 / $781.73	Professional		$152.38	$268.39	$781.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.15 / $81.90 / $216.64	Professional	26	$55.15	$81.90	$216.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.90 / $201.04 / $308.00	Professional	TC	$91.90	$201.04	$308.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.44 / $69.44 / $69.44	Facility	26	$69.44	$69.44	$69.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $164.32 / $298.18 / $465.32	Professional		$164.32	$298.18	$465.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.05 / $109.56 / $175.83	Professional	26	$60.05	$109.56	$175.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $103.03 / $188.68 / $306.77	Professional	TC	$103.03	$188.68	$306.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $301.50 / $338.03 / $411.20	Professional		$301.50	$338.03	$411.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $115.83 / $133.33 / $155.91	Professional	26	$115.83	$133.33	$155.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $182.11 / $206.73 / $255.32	Professional	TC	$182.11	$206.73	$255.32
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $248.50 / $331.50 / $484.85	Professional		$248.50	$331.50	$484.85
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $96.61 / $119.93 / $185.01	Professional	26	$96.61	$119.93	$185.01
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.31 / $209.81 / $308.14	Professional	TC	$147.31	$209.81	$308.14
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.67 / $119.39 / $122.61	Facility	26	$89.67	$119.39	$122.61
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $73.16 / $110.77 / $127.34	Professional	26	$73.16	$110.77	$127.34
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $141.19 / $224.95 / $337.48	Professional	TC	$141.19	$224.95	$337.48
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $69.44 / $69.44 / $69.44	Facility	26	$69.44	$69.44	$69.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $250.24 / $360.51 / $456.68	Professional		$250.24	$360.51	$456.68
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $62.64 / $109.56 / $177.01	Professional	26	$62.64	$109.56	$177.01
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $103.03 / $186.28 / $318.38	Professional	TC	$103.03	$186.28	$318.38
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 $278.89 / $369.28 / $442.19	Professional		$278.89	$369.28	$442.19
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $108.93 / $128.77 / $172.45	Professional	26	$108.93	$128.77	$172.45
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $169.97 / $225.30 / $295.82	Professional	TC	$169.97	$225.30	$295.82
United Facility/Professional Professional Modifier Low / Median / High Price $142.03 / $223.84 / $491.15	Professional		$142.03	$223.84	$491.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.59 / $81.81 / $188.11	Professional	26	$55.59	$81.81	$188.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.20 / $151.91 / $303.02	Professional	TC	$86.20	$151.91	$303.02