Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $102.33 / $114.82	Facility	26	$72.44	$102.33	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $123.03 / $251.19	Professional		$72.44	$123.03	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $45.71 / $151.36	Professional	26	$16.60	$45.71	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $74.13 / $169.82	Professional	TC	$41.69	$74.13	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $194.98 / $380.19	Professional		$117.49	$194.98	$380.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $70.79 / $128.82	Professional	26	$20.42	$70.79	$128.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $131.83 / $346.74	Professional	TC	$74.13	$131.83	$346.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $208.93 / $257.04	Professional		$181.97	$208.93	$257.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $95.50 / $114.82	Professional	26	$83.18	$95.50	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $109.65 / $138.04	Professional	TC	$97.72	$109.65	$138.04
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $114.82 / $114.82	Facility	26	$114.82	$114.82	$114.82
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $194.98 / $363.08	Professional		$144.54	$194.98	$363.08
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $91.20 / $141.25	Professional	26	$33.11	$91.20	$141.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $117.49 / $524.81	Professional	TC	$83.18	$117.49	$524.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $77.62 / $93.33	Facility	26	$28.18	$77.62	$93.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $33.88 / $87.10	Professional	26	$23.44	$33.88	$87.10
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $128.82 / $239.88	Professional	TC	$79.43	$128.82	$239.88
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.22 / $52.48 / $74.13	Facility	26	$11.22	$52.48	$74.13
Providence Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $208.93 / $302.00	Professional		$154.88	$208.93	$302.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $54.95 / $128.82	Professional	26	$26.30	$54.95	$128.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $141.25 / $288.40	Professional	TC	$85.11	$141.25	$288.40
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $199.53 / $263.03	Professional		$165.96	$199.53	$263.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $87.10 / $123.03	Professional	26	$32.36	$87.10	$123.03
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $123.03 / $154.88	Professional	TC	$93.33	$123.03	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $190.55 / $323.59	Professional		$93.33	$190.55	$323.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $50.12 / $120.23	Professional	26	$17.78	$50.12	$120.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $109.65 / $245.47	Professional	TC	$60.26	$109.65	$245.47