Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.90 / $82.97 / $178.07	Facility	26	$52.90	$82.97	$178.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.40 / $179.97 / $580.22	Professional		$102.40	$179.97	$580.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.46 / $45.43 / $114.00	Professional	26	$34.46	$45.43	$114.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.98 / $106.64 / $246.36	Professional	TC	$81.98	$106.64	$246.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.97 / $43.97 / $43.97	Facility	26	$43.97	$43.97	$43.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.60 / $254.26 / $369.75	Professional		$144.60	$254.26	$369.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.17 / $74.98 / $111.65	Professional	26	$43.17	$74.98	$111.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $103.92 / $179.65 / $257.64	Professional	TC	$103.92	$179.65	$257.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $248.43 / $294.95 / $340.99	Professional		$248.43	$294.95	$340.99
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $72.90 / $87.12 / $98.09	Professional	26	$72.90	$87.12	$98.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $173.29 / $206.91 / $242.93	Professional	TC	$173.29	$206.91	$242.93
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $201.22 / $237.46 / $382.26	Professional		$201.22	$237.46	$382.26
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.85 / $80.89 / $115.89	Professional	26	$60.85	$80.89	$115.89
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $140.37 / $185.89 / $266.33	Professional	TC	$140.37	$185.89	$266.33
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.78 / $75.15 / $77.52	Facility	26	$53.78	$75.15	$77.52
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $46.63 / $62.70 / $77.72	Professional	26	$46.63	$62.70	$77.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $120.84 / $153.27 / $180.78	Professional	TC	$120.84	$153.27	$180.78
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $43.97 / $43.97 / $43.97	Facility	26	$43.97	$43.97	$43.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $213.46 / $281.50 / $368.06	Professional		$213.46	$281.50	$368.06
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.90 / $76.88 / $112.11	Professional	26	$50.90	$76.88	$112.11
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $141.57 / $145.59 / $145.59	Professional	52	$141.57	$145.59	$145.59
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $118.69 / $188.11 / $261.48	Professional	TC	$118.69	$188.11	$261.48
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $243.57 / $243.57 / $243.57	Facility	26	$243.57	$243.57	$243.57
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $225.04 / $291.95 / $356.26	Professional		$225.04	$291.95	$356.26
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $68.23 / $88.52 / $108.02	Professional	26	$68.23	$88.52	$108.02
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $156.81 / $201.05 / $248.24	Professional	TC	$156.81	$201.05	$248.24
United Facility/Professional Professional Modifier Low / Median / High Price $140.16 / $167.02 / $389.55	Professional		$140.16	$167.02	$389.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.74 / $51.86 / $119.70	Professional	26	$43.74	$51.86	$119.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.01 / $122.93 / $268.30	Professional	TC	$104.01	$122.93	$268.30