Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.61 / $72.34 / $166.07	Facility	26	$49.61	$72.34	$166.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.95 / $158.28 / $505.00	Professional		$88.95	$158.28	$505.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.13 / $55.14 / $154.00	Professional	26	$32.13	$55.14	$154.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.82 / $69.69 / $177.66	Professional	TC	$56.82	$69.69	$177.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.57 / $200.33 / $273.38	Professional		$107.57	$200.33	$273.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.90 / $73.98 / $104.97	Professional	26	$40.90	$73.98	$104.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.65 / $126.34 / $169.14	Professional	TC	$66.65	$126.34	$169.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $176.03 / $202.63 / $247.66	Professional		$176.03	$202.63	$247.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $66.98 / $79.18 / $91.47	Professional	26	$66.98	$79.18	$91.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $108.09 / $126.47 / $156.19	Professional	TC	$108.09	$126.47	$156.19
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $146.77 / $161.07 / $283.64	Professional		$146.77	$161.07	$283.64
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.58 / $69.27 / $112.47	Professional	26	$56.58	$69.27	$112.47
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $90.21 / $112.47 / $179.32	Professional	TC	$90.21	$112.47	$179.32
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.41 / $70.04 / $73.03	Facility	26	$53.41	$70.04	$73.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $43.82 / $63.13 / $78.11	Professional	26	$43.82	$63.13	$78.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $70.98 / $101.91 / $126.65	Professional	TC	$70.98	$101.91	$126.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $164.70 / $205.72 / $270.63	Professional		$164.70	$205.72	$270.63
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.07 / $78.42 / $104.24	Professional	26	$48.07	$78.42	$104.24
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $77.92 / $130.97 / $169.14	Professional	TC	$77.92	$130.97	$169.14
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 $170.36 / $222.90 / $264.35	Professional		$170.36	$222.90	$264.35
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.54 / $85.89 / $101.38	Professional	26	$65.54	$85.89	$101.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $107.19 / $138.06 / $162.97	Professional	TC	$107.19	$138.06	$162.97
United Facility/Professional Professional Modifier Low / Median / High Price $97.44 / $113.09 / $279.07	Professional		$97.44	$113.09	$279.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.25 / $42.34 / $113.84	Professional	26	$38.25	$42.34	$113.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.19 / $70.79 / $178.20	Professional	TC	$59.19	$70.79	$178.20