Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.20 / $95.04 / $142.66	Facility	26	$65.20	$95.04	$142.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.46 / $199.51 / $567.00	Professional		$117.46	$199.51	$567.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.60 / $72.00 / $201.07	Professional	26	$42.60	$72.00	$201.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.03 / $89.26 / $199.97	Professional	TC	$69.03	$89.26	$199.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.19 / $254.02 / $346.15	Professional		$138.19	$254.02	$346.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.85 / $97.71 / $138.02	Professional	26	$53.85	$97.71	$138.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.13 / $156.31 / $209.46	Professional	TC	$84.13	$156.31	$209.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $223.46 / $260.41 / $314.04	Professional		$223.46	$260.41	$314.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $88.47 / $104.59 / $120.80	Professional	26	$88.47	$104.59	$120.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $133.72 / $156.47 / $193.24	Professional	TC	$133.72	$156.47	$193.24
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $186.27 / $204.16 / $359.88	Professional		$186.27	$204.16	$359.88
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.73 / $91.49 / $148.55	Professional	26	$74.73	$91.49	$148.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $111.54 / $147.37 / $221.73	Professional	TC	$111.54	$147.37	$221.73
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $70.06 / $92.50 / $95.81	Facility	26	$70.06	$92.50	$95.81
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $115.13 / $115.13 / $132.12	Professional		$115.13	$115.13	$132.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $56.68 / $80.12 / $95.81	Professional	26	$56.68	$80.12	$95.81
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $87.64 / $123.01 / $148.31	Professional	TC	$87.64	$123.01	$148.31
Providence Facility/Professional Professional Modifier Low / Median / High Price $210.45 / $259.45 / $341.44	Professional		$210.45	$259.45	$341.44
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $62.97 / $102.61 / $136.71	Professional	26	$62.97	$102.61	$136.71
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $96.49 / $162.46 / $209.46	Professional	TC	$96.49	$162.46	$209.46
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $216.48 / $282.24 / $335.42	Professional		$216.48	$282.24	$335.42
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $85.75 / $111.58 / $132.65	Professional	26	$85.75	$111.58	$132.65
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $130.90 / $170.98 / $202.76	Professional	TC	$130.90	$170.98	$202.76
United Facility/Professional Professional Modifier Low / Median / High Price $124.51 / $140.68 / $356.60	Professional		$124.51	$140.68	$356.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.15 / $54.99 / $145.75	Professional	26	$50.15	$54.99	$145.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.62 / $85.08 / $219.99	Professional	TC	$73.62	$85.08	$219.99