Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.43 / $102.60 / $218.56	Facility	26	$65.43	$102.60	$218.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.74 / $227.96 / $887.00	Professional		$151.74	$227.96	$887.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.89 / $54.62 / $196.32	Professional	26	$42.89	$54.62	$196.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.51 / $133.44 / $314.82	Professional	TC	$91.51	$133.44	$314.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $183.47 / $322.06 / $468.09	Professional		$183.47	$322.06	$468.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.63 / $92.46 / $137.66	Professional	26	$53.63	$92.46	$137.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $132.97 / $229.62 / $330.42	Professional	TC	$132.97	$229.62	$330.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $313.35 / $371.94 / $430.33	Professional		$313.35	$371.94	$430.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $89.74 / $107.23 / $120.73	Professional	26	$89.74	$107.23	$120.73
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $220.84 / $263.69 / $309.60	Professional	TC	$220.84	$263.69	$309.60
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $253.52 / $295.01 / $481.89	Professional		$253.52	$295.01	$481.89
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.73 / $100.04 / $142.32	Professional	26	$74.73	$100.04	$142.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $178.79 / $236.98 / $352.17	Professional	TC	$178.79	$236.98	$352.17
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $73.14 / $92.51 / $95.14	Facility	26	$73.14	$92.51	$95.14
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.96 / $77.00 / $93.80	Professional	26	$57.96	$77.00	$93.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $163.57 / $193.23 / $227.13	Professional	TC	$163.57	$193.23	$227.13
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $271.11 / $354.17 / $463.48	Professional		$271.11	$354.17	$463.48
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $62.71 / $95.23 / $137.66	Professional	26	$62.71	$95.23	$137.66
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $179.22 / $183.92 / $183.92	Professional	52	$179.22	$183.92	$183.92
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $151.30 / $240.74 / $334.68	Professional	TC	$151.30	$240.74	$334.68
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $311.07 / $311.07 / $311.07	Facility	26	$311.07	$311.07	$311.07
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $283.69 / $369.61 / $449.12	Professional		$283.69	$369.61	$449.12
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.79 / $108.71 / $132.65	Professional	26	$83.79	$108.71	$132.65
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $199.90 / $256.41 / $316.45	Professional	TC	$199.90	$256.41	$316.45
United Facility/Professional Professional Modifier Low / Median / High Price $187.96 / $205.90 / $492.00	Professional		$187.96	$205.90	$492.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.18 / $62.71 / $145.41	Professional	26	$52.18	$62.71	$145.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.54 / $142.13 / $345.22	Professional	TC	$120.54	$142.13	$345.22