Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.52 / $71.87 / $164.98	Facility	26	$65.52	$71.87	$164.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.36 / $123.65 / $420.00	Professional		$93.36	$123.65	$420.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.63 / $39.47 / $114.70	Professional	26	$27.63	$39.47	$114.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.97 / $81.98 / $193.04	Professional	TC	$59.97	$81.98	$193.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.82 / $37.82 / $37.82	Facility	26	$37.82	$37.82	$37.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.53 / $209.84 / $311.93	Professional		$117.53	$209.84	$311.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.35 / $64.73 / $95.92	Professional	26	$38.35	$64.73	$95.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.13 / $146.87 / $221.22	Professional	TC	$81.13	$146.87	$221.22
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $213.55 / $253.49 / $293.08	Professional		$213.55	$253.49	$293.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.20 / $75.52 / $85.03	Professional	26	$63.20	$75.52	$85.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $148.41 / $177.21 / $208.06	Professional	TC	$148.41	$177.21	$208.06
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $172.92 / $226.38 / $343.74	Professional		$172.92	$226.38	$343.74
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.83 / $70.23 / $100.65	Professional	26	$52.83	$70.23	$100.65
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.09 / $160.36 / $238.72	Professional	TC	$120.09	$160.36	$238.72
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.12 / $65.14 / $66.33	Facility	26	$43.12	$65.14	$66.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $35.82 / $53.90 / $65.66	Professional	26	$35.82	$53.90	$65.66
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $104.02 / $148.41 / $154.77	Professional	TC	$104.02	$148.41	$154.77
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $37.82 / $37.82 / $37.82	Facility	26	$37.82	$37.82	$37.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $180.54 / $245.68 / $322.05	Professional		$180.54	$245.68	$322.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.29 / $67.62 / $96.37	Professional	26	$44.29	$67.62	$96.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $108.72 / $159.60 / $221.65	Professional	TC	$108.72	$159.60	$221.65
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $614.12 / $614.12 / $614.12	Facility	26	$614.12	$614.12	$614.12
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $201.10 / $255.47 / $318.36	Professional		$201.10	$255.47	$318.36
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $59.25 / $76.09 / $93.80	Professional	26	$59.25	$76.09	$93.80
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $141.84 / $179.37 / $224.56	Professional	TC	$141.84	$179.37	$224.56
United Facility/Professional Professional Modifier Low / Median / High Price $109.62 / $132.59 / $315.77	Professional		$109.62	$132.59	$315.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.46 / $44.09 / $102.17	Professional	26	$35.46	$44.09	$102.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.29 / $92.28 / $213.94	Professional	TC	$74.29	$92.28	$213.94