Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.00 / $172.00 / $380.74	Facility	26	$86.00	$172.00	$380.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $187.10 / $234.80 / $867.00	Professional		$187.10	$234.80	$867.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.87 / $91.97 / $327.00	Professional	26	$72.87	$91.97	$327.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.74 / $150.21 / $564.00	Professional	TC	$103.74	$150.21	$564.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $94.15 / $94.15	Facility	26	$94.15	$94.15	$94.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.98 / $347.60 / $553.64	Professional		$199.98	$347.60	$553.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.27 / $148.38 / $239.94	Professional	26	$81.27	$148.38	$239.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $116.85 / $199.21 / $313.70	Professional	TC	$116.85	$199.21	$313.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $368.61 / $411.65 / $501.16	Professional		$368.61	$411.65	$501.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $156.82 / $180.52 / $211.00	Professional	26	$156.82	$180.52	$211.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $206.97 / $234.95 / $290.16	Professional	TC	$206.97	$234.95	$290.16
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $298.35 / $347.17 / $577.44	Professional		$298.35	$347.17	$577.44
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $130.76 / $173.82 / $251.10	Professional	26	$130.76	$173.82	$251.10
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $167.59 / $227.76 / $327.14	Professional	TC	$167.59	$227.76	$327.14
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $122.01 / $161.65 / $166.83	Facility	26	$122.01	$161.65	$166.83
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $173.42 / $173.42 / $289.92	Professional		$173.42	$173.42	$289.92
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $99.70 / $148.19 / $178.56	Professional	26	$99.70	$148.19	$178.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $142.78 / $204.75 / $243.95	Professional	TC	$142.78	$204.75	$243.95
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $94.15 / $94.15	Facility	26	$94.15	$94.15	$94.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $285.80 / $420.81 / $537.70	Professional		$285.80	$420.81	$537.70
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $83.13 / $148.38 / $239.94	Professional	26	$83.13	$148.38	$239.94
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $116.85 / $203.46 / $313.70	Professional	TC	$116.85	$203.46	$313.70
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $782.93 / $782.93 / $782.93	Facility	26	$782.93	$782.93	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $339.95 / $416.63 / $538.17	Professional		$339.95	$416.63	$538.17
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $147.83 / $175.46 / $234.03	Professional	26	$147.83	$175.46	$234.03
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $192.12 / $247.70 / $304.14	Professional	TC	$192.12	$247.70	$304.14
United Facility/Professional Professional Modifier Low / Median / High Price $172.70 / $272.56 / $581.91	Professional		$172.70	$272.56	$581.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.77 / $110.84 / $254.90	Professional	26	$75.77	$110.84	$254.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.93 / $164.31 / $341.52	Professional	TC	$96.93	$164.31	$341.52