Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.26 / $120.84 / $224.88	Facility	26	$98.26	$120.84	$224.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $127.71 / $174.28 / $371.00	Professional		$127.71	$174.28	$371.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.14 / $58.46 / $124.23	Professional	26	$42.14	$58.46	$124.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.58 / $125.67 / $285.00	Professional	TC	$82.58	$125.67	$285.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.84 / $51.84 / $51.84	Facility	26	$51.84	$51.84	$51.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $143.69 / $257.77 / $399.49	Professional		$143.69	$257.77	$399.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.28 / $82.23 / $131.77	Professional	26	$44.28	$82.23	$131.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $98.26 / $172.91 / $269.32	Professional	TC	$98.26	$172.91	$269.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $262.45 / $297.16 / $359.17	Professional		$262.45	$297.16	$359.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $85.66 / $99.55 / $114.96	Professional	26	$85.66	$99.55	$114.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $174.18 / $197.74 / $244.20	Professional	TC	$174.18	$197.74	$244.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $218.86 / $276.32 / $414.78	Professional		$218.86	$276.32	$414.78
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $71.51 / $89.10 / $137.25	Professional	26	$71.51	$89.10	$137.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $140.88 / $200.67 / $277.52	Professional	TC	$140.88	$200.67	$277.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $68.59 / $88.29 / $93.80	Facility	26	$68.59	$88.29	$93.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $63.84 / $82.94 / $105.99	Professional	26	$63.84	$82.94	$105.99
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $127.57 / $183.52 / $258.00	Professional	TC	$127.57	$183.52	$258.00
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $51.84 / $51.84 / $51.84	Facility	26	$51.84	$51.84	$51.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $213.05 / $305.91 / $389.94	Professional		$213.05	$305.91	$389.94
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.43 / $83.09 / $131.77	Professional	26	$45.43	$83.09	$131.77
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $98.26 / $172.91 / $279.85	Professional	TC	$98.26	$172.91	$279.85
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $209.36 / $209.36 / $209.36	Facility	26	$209.36	$209.36	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $244.19 / $303.20 / $386.58	Professional		$244.19	$303.20	$386.58
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $80.80 / $97.64 / $127.91	Professional	26	$80.80	$97.64	$127.91
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $163.38 / $208.10 / $258.67	Professional	TC	$163.38	$208.10	$258.67
United Facility/Professional Professional Modifier Low / Median / High Price $124.85 / $187.88 / $420.01	Professional		$124.85	$187.88	$420.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.03 / $51.91 / $140.28	Professional	26	$42.03	$51.91	$140.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.82 / $117.09 / $279.07	Professional	TC	$82.82	$117.09	$279.07