Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $103.20 / $115.47 / $236.97	Facility	26	$103.20	$115.47	$236.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.40 / $165.26 / $389.55	Professional		$134.40	$165.26	$389.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.28 / $67.70 / $152.80	Professional	26	$48.28	$67.70	$152.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $88.29 / $110.04 / $285.00	Professional	TC	$88.29	$110.04	$285.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $145.41 / $265.38 / $415.97	Professional		$145.41	$265.38	$415.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.42 / $90.15 / $147.74	Professional	26	$50.42	$90.15	$147.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $94.99 / $172.87 / $266.50	Professional	TC	$94.99	$172.87	$266.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $276.20 / $308.45 / $377.52	Professional		$276.20	$308.45	$377.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $97.28 / $112.18 / $130.90	Professional	26	$97.28	$112.18	$130.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $175.92 / $199.69 / $246.62	Professional	TC	$175.92	$199.69	$246.62
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $223.62 / $295.45 / $444.54	Professional		$223.62	$295.45	$444.54
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.13 / $107.85 / $155.55	Professional	26	$81.13	$107.85	$155.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $142.51 / $193.70 / $278.55	Professional	TC	$142.51	$193.70	$278.55
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.83 / $100.28 / $101.84	Facility	26	$66.83	$100.28	$101.84
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $106.95 / $106.95 / $106.95	Professional		$106.95	$106.95	$106.95
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $60.17 / $83.54 / $107.50	Professional	26	$60.17	$83.54	$107.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $146.83 / $175.93 / $181.57	Professional	TC	$146.83	$175.93	$181.57
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $205.20 / $313.02 / $406.81	Professional		$205.20	$313.02	$406.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.74 / $91.09 / $149.47	Professional	26	$51.74	$91.09	$149.47
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $99.22 / $174.29 / $266.50	Professional	TC	$99.22	$174.29	$266.50
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $272.64 / $272.64 / $272.64	Facility	26	$272.64	$272.64	$272.64
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $255.56 / $316.22 / $404.58	Professional		$255.56	$316.22	$404.58
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $91.57 / $113.28 / $144.97	Professional	26	$91.57	$113.28	$144.97
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $163.99 / $204.96 / $259.61	Professional	TC	$163.99	$204.96	$259.61
United Facility/Professional Professional Modifier Low / Median / High Price $133.78 / $205.49 / $448.50	Professional		$133.78	$205.49	$448.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.12 / $67.95 / $155.85	Professional	26	$46.12	$67.95	$155.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.55 / $108.25 / $291.51	Professional	TC	$87.55	$108.25	$291.51