Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $127.17 / $281.75	Facility	26	$105.78	$127.17	$281.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.47 / $263.42 / $761.00	Professional		$134.47	$263.42	$761.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.28 / $77.67 / $223.00	Professional	26	$51.28	$77.67	$223.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $84.26 / $195.40 / $350.55	Professional	TC	$84.26	$195.40	$350.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.44 / $64.44 / $64.44	Facility	26	$64.44	$64.44	$64.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $149.68 / $268.89 / $436.24	Professional		$149.68	$268.89	$436.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.45 / $101.70 / $164.22	Professional	26	$55.45	$101.70	$164.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $92.75 / $172.34 / $286.61	Professional	TC	$92.75	$172.34	$286.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $273.89 / $308.16 / $373.32	Professional		$273.89	$308.16	$373.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.01 / $124.24 / $143.96	Professional	26	$107.01	$124.24	$143.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $163.61 / $185.73 / $229.38	Professional	TC	$163.61	$185.73	$229.38
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $221.50 / $301.52 / $440.31	Professional		$221.50	$301.52	$440.31
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $111.22 / $170.79	Professional	26	$89.13	$111.22	$170.79
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $132.36 / $188.52 / $365.18	Professional	TC	$132.36	$188.52	$365.18
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $83.30 / $110.29 / $113.90	Facility	26	$83.30	$110.29	$113.90
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $78.25 / $86.94	Professional		$78.25	$78.25	$86.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $71.40 / $99.75 / $118.33	Professional	26	$71.40	$99.75	$118.33
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $119.54 / $169.51 / $277.50	Professional	TC	$119.54	$169.51	$277.50
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $64.44 / $64.44 / $64.44	Facility	26	$64.44	$64.44	$64.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $227.15 / $320.72 / $411.07	Professional		$227.15	$320.72	$411.07
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.08 / $101.84 / $164.22	Professional	26	$58.08	$101.84	$164.22
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $92.75 / $170.90 / $272.52	Professional	TC	$92.75	$170.90	$272.52
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 $253.76 / $322.69 / $402.91	Professional		$253.76	$322.69	$402.91
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.55 / $120.28 / $159.18	Professional	26	$100.55	$120.28	$159.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $153.22 / $196.45 / $246.43	Professional	TC	$153.22	$196.45	$246.43
United Facility/Professional Professional Modifier Low / Median / High Price $128.84 / $197.05 / $446.89	Professional		$128.84	$197.05	$446.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.62 / $69.81 / $174.05	Professional	26	$51.62	$69.81	$174.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.00 / $124.17 / $269.82	Professional	TC	$77.00	$124.17	$269.82