Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.37 / $74.79 / $164.98	Facility	26	$56.37	$74.79	$164.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.20 / $91.78 / $345.00	Professional		$69.20	$91.78	$345.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.30 / $38.77 / $104.80	Professional	26	$27.30	$38.77	$104.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.72 / $52.77 / $124.41	Professional	TC	$38.72	$52.77	$124.41
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.82 / $37.82 / $37.82	Facility	26	$37.82	$37.82	$37.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $88.71 / $157.66 / $235.86	Professional		$88.71	$157.66	$235.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.35 / $64.73 / $95.92	Professional	26	$38.35	$64.73	$95.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $52.24 / $94.58 / $142.71	Professional	TC	$52.24	$94.58	$142.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $160.69 / $190.25 / $218.99	Professional		$160.69	$190.25	$218.99
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.20 / $75.52 / $85.03	Professional	26	$63.20	$75.52	$85.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $95.55 / $114.09 / $133.97	Professional	TC	$95.55	$114.09	$133.97
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $130.22 / $171.47 / $258.89	Professional		$130.22	$171.47	$258.89
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.83 / $70.23 / $100.65	Professional	26	$52.83	$70.23	$100.65
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.39 / $103.43 / $153.83	Professional	TC	$77.39	$103.43	$153.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.12 / $65.14 / $66.33	Facility	26	$43.12	$65.14	$66.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $39.08 / $53.90 / $65.66	Professional	26	$39.08	$53.90	$65.66
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $79.73 / $90.45 / $99.83	Professional	TC	$79.73	$90.45	$99.83
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $37.82 / $37.82 / $37.82	Facility	26	$37.82	$37.82	$37.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $136.88 / $184.15 / $241.71	Professional		$136.88	$184.15	$241.71
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.29 / $67.62 / $96.37	Professional	26	$44.29	$67.62	$96.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $69.94 / $102.97 / $143.00	Professional	TC	$69.94	$102.97	$143.00
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $150.22 / $191.80 / $237.82	Professional		$150.22	$191.80	$237.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $59.25 / $76.09 / $93.80	Professional	26	$59.25	$76.09	$93.80
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $90.97 / $115.70 / $144.02	Professional	TC	$90.97	$115.70	$144.02
United Facility/Professional Professional Modifier Low / Median / High Price $83.11 / $90.48 / $239.43	Professional		$83.11	$90.48	$239.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.46 / $44.09 / $102.17	Professional	26	$35.46	$44.09	$102.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.73 / $56.70 / $137.47	Professional	TC	$47.73	$56.70	$137.47