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 / $225.15	Facility	26	$86.00	$106.13	$225.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $127.38 / $256.77 / $872.99	Professional		$127.38	$256.77	$872.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.14 / $60.00 / $203.30	Professional	26	$44.14	$60.00	$203.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.57 / $201.04 / $303.82	Professional	TC	$85.57	$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 $141.94 / $313.05 / $438.59	Professional		$141.94	$313.05	$438.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.50 / $85.53 / $137.44	Professional	26	$46.50	$85.53	$137.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.26 / $222.99 / $321.20	Professional	TC	$95.26	$222.99	$321.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $260.08 / $290.75 / $355.66	Professional		$260.08	$290.75	$355.66
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 $167.57 / $190.23 / $234.94	Professional	TC	$167.57	$190.23	$234.94
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $216.67 / $301.50 / $442.24	Professional		$216.67	$301.50	$442.24
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.73 / $101.43 / $142.32	Professional	26	$74.73	$101.43	$142.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $135.56 / $193.08 / $383.16	Professional	TC	$135.56	$193.08	$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 $104.84 / $104.84 / $104.84	Professional		$104.84	$104.84	$104.84
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.20 / $82.29 / $99.22	Professional	26	$57.20	$82.29	$99.22
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $141.35 / $220.09 / $304.92	Professional	TC	$141.35	$220.09	$304.92
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 $229.41 / $323.20 / $423.57	Professional		$229.41	$323.20	$423.57
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.54 / $85.53 / $137.66	Professional	26	$48.54	$85.53	$137.66
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $95.26 / $215.17 / $308.51	Professional	TC	$95.26	$215.17	$308.51
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 $239.40 / $323.64 / $418.12	Professional		$239.40	$323.64	$418.12
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 $155.61 / $210.87 / $295.24	Professional	TC	$155.61	$210.87	$295.24
United Facility/Professional Professional Modifier Low / Median / High Price $133.75 / $249.30 / $444.00	Professional		$133.75	$249.30	$444.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.38 / $55.92 / $145.41	Professional	26	$43.38	$55.92	$145.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.19 / $152.88 / $301.04	Professional	TC	$90.19	$152.88	$301.04