Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $89.13 / $112.20	Facility	26	$56.23	$89.13	$112.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $194.98 / $602.56	Professional		$97.72	$194.98	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $75.86 / $239.88	Professional	26	$36.31	$75.86	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $77.62 / $199.53	Professional	TC	$56.23	$77.62	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $213.80 / $316.23	Professional		$102.33	$213.80	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $75.86 / $117.49	Professional	26	$42.66	$75.86	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $134.90 / $199.53	Professional	TC	$66.07	$134.90	$199.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $234.42 / $295.12	Professional		$190.55	$234.42	$295.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $85.11 / $102.33	Professional	26	$66.07	$85.11	$102.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $151.36 / $190.55	Professional	TC	$123.03	$151.36	$190.55
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $79.43 / $112.20	Facility	26	$56.23	$79.43	$112.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $208.93 / $331.13	Professional		$125.89	$208.93	$331.13
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $83.18 / $128.82	Professional	26	$45.71	$83.18	$128.82
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $138.04 / $199.53	Professional	TC	$72.44	$138.04	$199.53
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $79.43 / $85.11	Facility	26	$61.66	$79.43	$85.11
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $56.23 / $56.23	Professional		$56.23	$56.23	$56.23
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $72.44 / $89.13	Professional	26	$50.12	$72.44	$89.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $123.03 / $151.36	Professional	TC	$83.18	$123.03	$151.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $223.87 / $316.23	Professional		$173.78	$223.87	$316.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $83.18 / $114.82	Professional	26	$54.95	$83.18	$114.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $141.25 / $199.53	Professional	TC	$97.72	$141.25	$199.53
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $234.42 / $302.00	Professional		$199.53	$234.42	$302.00
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $87.10 / $114.82	Professional	26	$74.13	$87.10	$114.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $147.91 / $190.55	Professional	TC	$125.89	$147.91	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $123.03 / $302.00	Professional		$109.65	$123.03	$302.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $46.77 / $112.20	Professional	26	$41.69	$46.77	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $79.43 / $190.55	Professional	TC	$69.18	$79.43	$190.55