Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.00 / $105.78 / $225.15	Facility	26	$86.00	$105.78	$225.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $136.59 / $259.68 / $689.27	Professional		$136.59	$259.68	$689.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.25 / $62.14 / $224.40	Professional	26	$45.25	$62.14	$224.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $84.52 / $201.04 / $303.82	Professional	TC	$84.52	$201.04	$303.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $143.54 / $321.02 / $468.35	Professional		$143.54	$321.02	$468.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.50 / $90.96 / $137.66	Professional	26	$46.50	$90.96	$137.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.99 / $225.59 / $324.54	Professional	TC	$95.99	$225.59	$324.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $261.39 / $292.20 / $357.51	Professional		$261.39	$292.20	$357.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $89.74 / $103.94 / $120.73	Professional	26	$89.74	$103.94	$120.73
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $168.90 / $191.72 / $236.78	Professional	TC	$168.90	$191.72	$236.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $217.75 / $302.50 / $443.52	Professional		$217.75	$302.50	$443.52
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.73 / $100.80 / $142.32	Professional	26	$74.73	$100.80	$142.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $136.63 / $194.60 / $386.82	Professional	TC	$136.63	$194.60	$386.82
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $92.51 / $102.51	Facility	26	$74.13	$92.51	$102.51
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $86.94 / $86.94 / $119.08	Professional		$86.94	$86.94	$119.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $67.50 / $89.09 / $109.21	Professional	26	$67.50	$89.09	$109.21
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $153.04 / $228.00 / $310.52	Professional	TC	$153.04	$228.00	$310.52
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $230.60 / $325.08 / $425.57	Professional		$230.60	$325.08	$425.57
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.54 / $90.96 / $137.66	Professional	26	$48.54	$90.96	$137.66
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $95.99 / $216.83 / $312.12	Professional	TC	$95.99	$216.83	$312.12
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 $240.60 / $325.26 / $421.50	Professional		$240.60	$325.26	$421.50
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.79 / $103.21 / $132.65	Professional	26	$83.79	$103.21	$132.65
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $156.81 / $213.33 / $298.29	Professional	TC	$156.81	$213.33	$298.29
United Facility/Professional Professional Modifier Low / Median / High Price $134.36 / $246.36 / $446.23	Professional		$134.36	$246.36	$446.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.56 / $68.09 / $145.41	Professional	26	$43.56	$68.09	$145.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.80 / $150.44 / $301.02	Professional	TC	$90.80	$150.44	$301.02