Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.05 / $106.13 / $218.56	Facility	26	$93.05	$106.13	$218.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.00 / $247.66 / $688.49	Professional		$109.00	$247.66	$688.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.63 / $71.86 / $236.00	Professional	26	$44.63	$71.86	$236.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $104.00 / $208.96 / $560.45	Professional	TC	$104.00	$208.96	$560.45
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 $178.29 / $319.45 / $489.21	Professional		$178.29	$319.45	$489.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.50 / $85.53 / $137.63	Professional	26	$46.50	$85.53	$137.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $130.57 / $232.09 / $360.84	Professional	TC	$130.57	$232.09	$360.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $322.61 / $367.77 / $443.31	Professional		$322.61	$367.77	$443.31
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 $230.10 / $263.82 / $322.58	Professional	TC	$230.10	$263.82	$322.58
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $268.89 / $314.95 / $511.35	Professional		$268.89	$314.95	$511.35
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.73 / $98.73 / $142.32	Professional	26	$74.73	$98.73	$142.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.27 / $265.29 / $370.28	Professional	TC	$186.27	$265.29	$370.28
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $70.06 / $92.51 / $96.48	Facility	26	$70.06	$92.51	$96.48
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $108.55 / $115.10 / $115.13	Professional		$108.55	$115.10	$115.13
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.89 / $82.08 / $100.50	Professional	26	$57.89	$82.08	$100.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $158.79 / $232.96 / $328.51	Professional	TC	$158.79	$232.96	$328.51
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 $264.01 / $376.50 / $482.60	Professional		$264.01	$376.50	$482.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.54 / $86.08 / $137.66	Professional	26	$48.54	$86.08	$137.66
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $130.57 / $232.09 / $363.36	Professional	TC	$130.57	$232.09	$363.36
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 $301.05 / $380.64 / $476.59	Professional		$301.05	$380.64	$476.59
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 $217.26 / $278.70 / $343.94	Professional	TC	$217.26	$278.70	$343.94
United Facility/Professional Professional Modifier Low / Median / High Price $154.30 / $227.27 / $519.90	Professional		$154.30	$227.27	$519.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.38 / $63.77 / $145.41	Professional	26	$43.38	$63.77	$145.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $184.89 / $373.12	Professional	TC	$109.65	$184.89	$373.12