Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.50 / $86.17 / $176.51	Facility	26	$64.50	$86.17	$176.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $101.04 / $131.28 / $615.00	Professional		$101.04	$131.28	$615.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.91 / $52.44 / $173.54	Professional	26	$29.91	$52.44	$173.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.97 / $87.26 / $213.13	Professional	TC	$65.97	$87.26	$213.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.57 / $43.57 / $43.57	Facility	26	$43.57	$43.57	$43.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $118.88 / $222.55 / $344.48	Professional		$118.88	$222.55	$344.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.59 / $68.16 / $104.94	Professional	26	$37.59	$68.16	$104.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.69 / $155.33 / $246.43	Professional	TC	$83.69	$155.33	$246.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $238.74 / $283.29 / $327.52	Professional		$238.74	$283.29	$327.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $72.90 / $87.19 / $98.16	Professional	26	$72.90	$87.19	$98.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $163.61 / $195.36 / $229.38	Professional	TC	$163.61	$195.36	$229.38
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $163.00 / $207.70 / $380.22	Professional		$163.00	$207.70	$380.22
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.85 / $74.50 / $115.89	Professional	26	$60.85	$74.50	$115.89
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $121.44 / $162.04 / $263.12	Professional	TC	$121.44	$162.04	$263.12
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $48.51 / $68.00 / $76.84	Facility	26	$48.51	$68.00	$76.84
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $119.19 / $119.19 / $132.44	Professional		$119.19	$119.19	$132.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $40.88 / $56.43 / $75.14	Professional	26	$40.88	$56.43	$75.14
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $92.06 / $130.53 / $169.46	Professional	TC	$92.06	$130.53	$169.46
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $43.57 / $43.57 / $43.57	Facility	26	$43.57	$43.57	$43.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $187.62 / $264.93 / $356.96	Professional		$187.62	$264.93	$356.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.01 / $73.11 / $106.06	Professional	26	$50.01	$73.11	$106.06
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $110.31 / $174.02 / $246.43	Professional	TC	$110.31	$174.02	$246.43
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.78 / $851.78 / $851.78	Facility	26	$851.78	$851.78	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $209.84 / $255.76 / $343.88	Professional		$209.84	$255.76	$343.88
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $61.50 / $77.75 / $108.02	Professional	26	$61.50	$77.75	$108.02
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $148.22 / $177.23 / $240.79	Professional	TC	$148.22	$177.23	$240.79
United Facility/Professional Professional Modifier Low / Median / High Price $114.63 / $147.00 / $350.38	Professional		$114.63	$147.00	$350.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.53 / $50.96 / $117.76	Professional	26	$35.53	$50.96	$117.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.59 / $95.93 / $231.17	Professional	TC	$78.59	$95.93	$231.17