Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.97 / $116.25 / $238.53	Facility	26	$95.97	$116.25	$238.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $139.37 / $262.57 / $695.00	Professional		$139.37	$262.57	$695.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.60 / $66.51 / $196.00	Professional	26	$49.60	$66.51	$196.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.24 / $196.81 / $305.89	Professional	TC	$85.24	$196.81	$305.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.04 / $59.04 / $59.04	Facility	26	$59.04	$59.04	$59.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $145.94 / $263.02 / $424.92	Professional		$145.94	$263.02	$424.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.74 / $92.77 / $148.16	Professional	26	$50.74	$92.77	$148.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.86 / $175.06 / $290.01	Professional	TC	$93.86	$175.06	$290.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $267.20 / $299.02 / $364.83	Professional		$267.20	$299.02	$364.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $97.94 / $112.95 / $131.72	Professional	26	$97.94	$112.95	$131.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $166.24 / $188.72 / $233.07	Professional	TC	$166.24	$188.72	$233.07
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $134.49 / $266.50 / $429.68	Professional		$134.49	$266.50	$429.68
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.66 / $103.46 / $156.57	Professional	26	$81.66	$103.46	$156.57
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $134.49 / $191.55 / $376.96	Professional	TC	$134.49	$191.55	$376.96
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $76.44 / $100.95 / $104.52	Facility	26	$76.44	$100.95	$104.52
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $90.04 / $119.08 / $160.15	Professional		$90.04	$119.08	$160.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $62.40 / $94.07 / $112.81	Professional	26	$62.40	$94.07	$112.81
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $115.34 / $171.68 / $358.14	Professional	TC	$115.34	$171.68	$358.14
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $59.04 / $59.04 / $59.04	Facility	26	$59.04	$59.04	$59.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $221.40 / $313.01 / $400.00	Professional		$221.40	$313.01	$400.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $52.95 / $92.77 / $150.46	Professional	26	$52.95	$92.77	$150.46
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $93.86 / $173.59 / $276.31	Professional	TC	$93.86	$173.59	$276.31
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 $247.18 / $315.98 / $392.60	Professional		$247.18	$315.98	$392.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $92.17 / $109.66 / $145.91	Professional	26	$92.17	$109.66	$145.91
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $155.01 / $198.78 / $249.24	Professional	TC	$155.01	$198.78	$249.24
United Facility/Professional Professional Modifier Low / Median / High Price $125.47 / $251.91 / $427.86	Professional		$125.47	$251.91	$427.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.24 / $68.39 / $158.94	Professional	26	$47.24	$68.39	$158.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.23 / $165.75 / $268.30	Professional	TC	$78.23	$165.75	$268.30