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 / $218.56	Facility	26	$86.00	$105.78	$218.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.98 / $236.00 / $613.25	Professional		$66.98	$236.00	$613.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.61 / $66.98 / $245.00	Professional	26	$46.61	$66.98	$245.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.90 / $201.03 / $303.82	Professional	TC	$85.90	$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 $142.31 / $313.05 / $439.72	Professional		$142.31	$313.05	$439.72
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 $95.46 / $222.04 / $309.70	Professional	TC	$95.46	$222.04	$309.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $260.74 / $291.18 / $356.60	Professional		$260.74	$291.18	$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 / $301.00 / $419.58	Professional		$217.21	$301.00	$419.58
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 $136.09 / $193.83 / $282.86	Professional	TC	$136.09	$193.83	$282.86
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 $86.94 / $86.94 / $86.94	Professional		$86.94	$86.94	$86.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.89 / $85.80 / $102.51	Professional	26	$57.89	$85.80	$102.51
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $151.90 / $208.05 / $328.32	Professional	TC	$151.90	$208.05	$328.32
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 / $322.64 / $413.03	Professional		$230.00	$322.64	$413.03
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 $95.46 / $215.17 / $309.70	Professional	TC	$95.46	$215.17	$309.70
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 $240.00 / $323.79 / $416.63	Professional		$240.00	$323.79	$416.63
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 $156.21 / $211.69 / $294.51	Professional	TC	$156.21	$211.69	$294.51
United Facility/Professional Professional Modifier Low / Median / High Price $133.75 / $202.73 / $445.12	Professional		$133.75	$202.73	$445.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.38 / $63.77 / $146.55	Professional	26	$43.38	$63.77	$146.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.19 / $167.04 / $298.99	Professional	TC	$90.19	$167.04	$298.99