Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.00 / $106.13 / $218.56	Facility	26	$86.00	$106.13	$218.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.04 / $255.01 / $877.07	Professional		$128.04	$255.01	$877.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.14 / $71.86 / $219.30	Professional	26	$44.14	$71.86	$219.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $84.89 / $201.03 / $303.82	Professional	TC	$84.89	$201.03	$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 $142.66 / $314.29 / $467.15	Professional		$142.66	$314.29	$467.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.50 / $85.53 / $137.66	Professional	26	$46.50	$85.53	$137.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.83 / $223.26 / $310.92	Professional	TC	$95.83	$223.26	$310.92
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $260.74 / $291.47 / $356.60	Professional		$260.74	$291.47	$356.60
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 $168.23 / $190.99 / $235.87	Professional	TC	$168.23	$190.99	$235.87
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $217.21 / $300.26 / $443.52	Professional		$217.21	$300.26	$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 $136.09 / $193.83 / $383.16	Professional	TC	$136.09	$193.83	$383.16
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $70.06 / $92.51 / $97.92	Facility	26	$70.06	$92.51	$97.92
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $78.25 / $78.25	Professional		$78.25	$78.25	$78.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.20 / $85.80 / $108.28	Professional	26	$57.20	$85.80	$108.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $147.19 / $230.84 / $320.76	Professional	TC	$147.19	$230.84	$320.76
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 $230.00 / $324.17 / $426.36	Professional		$230.00	$324.17	$426.36
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.72 / $85.53 / $137.66	Professional	26	$47.72	$85.53	$137.66
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $95.83 / $216.00 / $310.92	Professional	TC	$95.83	$216.00	$310.92
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 / $324.58 / $420.04	Professional		$240.60	$324.58	$420.04
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.79 / $101.17 / $132.65	Professional	26	$83.79	$101.17	$132.65
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $156.81 / $212.51 / $296.45	Professional	TC	$156.81	$212.51	$296.45
United Facility/Professional Professional Modifier Low / Median / High Price $134.36 / $227.76 / $452.01	Professional		$134.36	$227.76	$452.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.38 / $66.63 / $146.78	Professional	26	$43.38	$66.63	$146.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.80 / $153.91 / $301.02	Professional	TC	$90.80	$153.91	$301.02