Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.79 / $106.32 / $244.68	Facility	26	$67.79	$106.32	$244.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.45 / $159.68 / $370.07	Professional		$109.45	$159.68	$370.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $57.82 / $152.02	Professional	26	$31.76	$57.82	$152.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.54 / $107.09 / $263.33	Professional	TC	$79.54	$107.09	$263.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.98 / $55.98 / $55.98	Facility	26	$55.98	$55.98	$55.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $146.19 / $292.88 / $451.10	Professional		$146.19	$292.88	$451.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.43 / $81.81 / $135.59	Professional	26	$38.43	$81.81	$135.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $108.66 / $219.48 / $316.87	Professional	TC	$108.66	$219.48	$316.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $298.44 / $353.84 / $409.09	Professional		$298.44	$353.84	$409.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $92.98 / $111.08 / $125.06	Professional	26	$92.98	$111.08	$125.06
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $202.58 / $241.88 / $284.02	Professional	TC	$202.58	$241.88	$284.02
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $234.50 / $255.87 / $474.75	Professional		$234.50	$255.87	$474.75
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.36 / $94.74 / $148.44	Professional	26	$63.36	$94.74	$148.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $163.85 / $216.47 / $326.33	Professional	TC	$163.85	$216.47	$326.33
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $56.43 / $83.22 / $98.49	Facility	26	$56.43	$83.22	$98.49
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $39.40 / $58.14 / $100.98	Professional	26	$39.40	$58.14	$100.98
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $129.60 / $185.86 / $235.13	Professional	TC	$129.60	$185.86	$235.13
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $55.98 / $55.98 / $55.98	Facility	26	$55.98	$55.98	$55.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $248.37 / $339.38 / $449.35	Professional		$248.37	$339.38	$449.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $49.48 / $89.54 / $137.04	Professional	26	$49.48	$89.54	$137.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $148.13 / $229.74 / $335.41	Professional	TC	$148.13	$229.74	$335.41
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 $279.50 / $321.20 / $436.64	Professional		$279.50	$321.20	$436.64
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $62.72 / $98.26 / $138.34	Professional	26	$62.72	$98.26	$138.34
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $192.12 / $234.24 / $299.83	Professional	TC	$192.12	$234.24	$299.83
United Facility/Professional Professional Modifier Low / Median / High Price $150.91 / $177.72 / $451.01	Professional		$150.91	$177.72	$451.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.53 / $53.05 / $151.27	Professional	26	$35.53	$53.05	$151.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $101.70 / $126.45 / $332.53	Professional	TC	$101.70	$126.45	$332.53