Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.35 / $71.12 / $140.60	Facility	26	$45.35	$71.12	$140.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.58 / $138.41 / $574.00	Professional		$100.58	$138.41	$574.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $47.70 / $141.38	Professional	26	$29.75	$47.70	$141.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.37 / $102.17 / $414.00	Professional	TC	$76.37	$102.17	$414.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $122.38 / $229.63 / $314.43	Professional		$122.38	$229.63	$314.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.53 / $67.61 / $95.25	Professional	26	$37.53	$67.61	$95.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.03 / $162.66 / $216.34	Professional	TC	$84.03	$162.66	$216.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $200.75 / $231.09 / $283.89	Professional		$200.75	$231.09	$283.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.22 / $72.41 / $83.60	Professional	26	$61.22	$72.41	$83.60
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $138.63 / $162.19 / $200.30	Professional	TC	$138.63	$162.19	$200.30
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $167.59 / $190.23 / $323.27	Professional		$167.59	$190.23	$323.27
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.78 / $63.39 / $102.93	Professional	26	$51.78	$63.39	$102.93
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $115.81 / $152.72 / $230.22	Professional	TC	$115.81	$152.72	$230.22
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $48.02 / $64.04 / $66.33	Facility	26	$48.02	$64.04	$66.33
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $86.94 / $86.94	Professional		$78.25	$86.94	$86.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $40.96 / $55.31 / $69.80	Professional	26	$40.96	$55.31	$69.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $96.88 / $127.00 / $166.37	Professional	TC	$96.88	$127.00	$166.37
Providence Facility/Professional Professional Modifier Low / Median / High Price $188.21 / $234.81 / $309.24	Professional		$188.21	$234.81	$309.24
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.42 / $71.33 / $94.40	Professional	26	$43.42	$71.33	$94.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $100.11 / $168.04 / $216.34	Professional	TC	$100.11	$168.04	$216.34
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 $193.11 / $253.37 / $301.30	Professional		$193.11	$253.37	$301.30
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $59.78 / $78.66 / $92.86	Professional	26	$59.78	$78.66	$92.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $137.19 / $177.40 / $208.45	Professional	TC	$137.19	$177.40	$208.45
United Facility/Professional Professional Modifier Low / Median / High Price $111.39 / $126.23 / $319.39	Professional		$111.39	$126.23	$319.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.86 / $42.87 / $103.30	Professional	26	$34.86	$42.87	$103.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $76.51 / $91.05 / $227.91	Professional	TC	$76.51	$91.05	$227.91