Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $136.33 / $175.07 / $258.67	Facility	26	$136.33	$175.07	$258.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $175.99 / $212.33 / $735.00	Professional		$175.99	$212.33	$735.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $96.29 / $120.29 / $428.85	Professional	26	$96.29	$120.29	$428.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $73.06 / $87.24 / $160.68	Professional	TC	$73.06	$87.24	$160.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.19 / $118.19 / $118.19	Facility	26	$118.19	$118.19	$118.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $238.83 / $378.91 / $517.17	Professional		$238.83	$378.91	$517.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $135.35 / $217.32 / $296.91	Professional	26	$135.35	$217.32	$296.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $103.48 / $166.25 / $225.27	Professional	TC	$103.48	$166.25	$225.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $309.76 / $403.88 / $462.84	Professional		$309.76	$403.88	$462.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $182.55 / $238.03 / $268.66	Professional	26	$182.55	$238.03	$268.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $127.20 / $165.38 / $194.17	Professional	TC	$127.20	$165.38	$194.17
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $277.00 / $335.42 / $530.66	Professional		$277.00	$335.42	$530.66
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $164.92 / $191.90 / $327.84	Professional	26	$164.92	$191.90	$327.84
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $112.08 / $135.86 / $222.81	Professional	TC	$112.08	$135.86	$222.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $148.74 / $204.40 / $207.03	Facility	26	$148.74	$204.40	$207.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $120.20 / $170.43 / $221.04	Professional	26	$120.20	$170.43	$221.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $88.84 / $129.80 / $171.36	Professional	TC	$88.84	$129.80	$171.36
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $118.19 / $118.19 / $118.19	Facility	26	$118.19	$118.19	$118.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $241.00 / $385.70 / $505.40	Professional		$241.00	$385.70	$505.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $140.88 / $217.32 / $296.91	Professional	26	$140.88	$217.32	$296.91
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $103.02 / $172.74 / $228.32	Professional	TC	$103.02	$172.74	$228.32
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $838.61 / $838.61 / $838.61	Facility	26	$838.61	$838.61	$838.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $281.88 / $362.06 / $494.60	Professional		$281.88	$362.06	$494.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $165.78 / $204.62 / $290.88	Professional	26	$165.78	$204.62	$290.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $116.10 / $157.69 / $203.71	Professional	TC	$116.10	$157.69	$203.71
United Facility/Professional Professional Modifier Low / Median / High Price $276.43 / $390.03 / $555.35	Professional		$276.43	$390.03	$555.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $157.09 / $215.61 / $323.57	Professional	26	$157.09	$215.61	$323.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.27 / $165.33 / $230.24	Professional	TC	$116.27	$165.33	$230.24