Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.56 / $115.28 / $226.71	Facility	26	$98.56	$115.28	$226.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.88 / $156.85 / $256.08	Professional		$75.88	$156.85	$256.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.71 / $37.93 / $102.91	Professional	26	$16.71	$37.93	$102.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.47 / $127.76 / $187.57	Professional	TC	$38.47	$127.76	$187.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.72 / $52.72 / $52.72	Facility	26	$52.72	$52.72	$52.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.01 / $195.62 / $332.57	Professional		$131.01	$195.62	$332.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.53 / $65.09 / $122.63	Professional	26	$24.53	$65.09	$122.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.45 / $131.83 / $201.66	Professional	TC	$80.45	$131.83	$201.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $188.57 / $222.94 / $255.42	Professional		$188.57	$222.94	$255.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $86.53 / $102.94 / $115.90	Professional	26	$86.53	$102.94	$115.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $99.53 / $118.84 / $139.52	Professional	TC	$99.53	$118.84	$139.52
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $145.00 / $178.23 / $304.48	Professional		$145.00	$178.23	$304.48
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.65 / $92.82 / $139.29	Professional	26	$33.65	$92.82	$139.29
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $80.59 / $114.77 / $529.10	Professional	TC	$80.59	$114.77	$529.10
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $28.50 / $78.09 / $92.46	Facility	26	$28.50	$78.09	$92.46
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $22.93 / $31.86 / $83.21	Professional	26	$22.93	$31.86	$83.21
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $83.09 / $127.00 / $241.28	Professional	TC	$83.09	$127.00	$241.28
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $52.72 / $52.72 / $52.72	Facility	26	$52.72	$52.72	$52.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $149.44 / $216.97 / $289.45	Professional		$149.44	$216.97	$289.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $25.76 / $75.43 / $128.59	Professional	26	$25.76	$75.43	$128.59
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $80.45 / $130.55 / $184.26	Professional	TC	$80.45	$130.55	$184.26
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $170.30 / $207.34 / $275.72	Professional		$170.30	$207.34	$275.72
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $32.00 / $92.20 / $129.81	Professional	26	$32.00	$92.20	$129.81
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $92.17 / $125.54 / $159.19	Professional	TC	$92.17	$125.54	$159.19
United Facility/Professional Professional Modifier Low / Median / High Price $88.76 / $177.99 / $314.20	Professional		$88.76	$177.99	$314.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.32 / $49.80 / $141.94	Professional	26	$18.32	$49.80	$141.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.91 / $94.23 / $171.58	Professional	TC	$59.91	$94.23	$171.58