Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.89 / $60.07 / $200.38	Facility	26	$49.89	$60.07	$200.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.46 / $115.49 / $437.44	Professional		$55.46	$115.49	$437.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $36.97 / $156.00	Professional	26	$24.78	$36.97	$156.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.29 / $78.92 / $138.78	Professional	TC	$12.29	$78.92	$138.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $99.99 / $149.47 / $248.04	Professional		$99.99	$149.47	$248.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.21 / $69.18 / $116.91	Professional	26	$34.21	$69.18	$116.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.69 / $79.30 / $182.79	Professional	TC	$23.69	$79.30	$182.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.24 / $119.15 / $139.65	Professional		$102.24	$119.15	$139.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $80.81 / $95.52 / $110.37	Professional	26	$80.81	$95.52	$110.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.30 / $23.71 / $29.29	Professional	TC	$20.30	$23.71	$29.29
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $70.38 / $111.77 / $184.62	Professional		$70.38	$111.77	$184.62
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $68.31 / $84.87 / $135.79	Professional	26	$68.31	$84.87	$135.79
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.07 / $22.92 / $33.95	Professional	TC	$17.07	$22.92	$33.95
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.61 / $70.34 / $85.76	Facility	26	$43.61	$70.34	$85.76
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $77.84 / $86.49 / $146.80	Professional		$77.84	$86.49	$146.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $38.25 / $59.40 / $84.48	Professional	26	$38.25	$59.40	$84.48
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $20.91 / $114.30 / $168.44	Professional	TC	$20.91	$114.30	$168.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $102.24 / $140.16 / $221.10	Professional		$102.24	$140.16	$221.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.43 / $70.95 / $112.31	Professional	26	$38.43	$70.95	$112.31
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $24.19 / $78.05 / $185.05	Professional	TC	$24.19	$78.05	$185.05
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 $101.43 / $136.21 / $201.57	Professional		$101.43	$136.21	$201.57
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.60 / $85.01 / $121.28	Professional	26	$57.60	$85.01	$121.28
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $20.79 / $29.04 / $124.67	Professional	TC	$20.79	$29.04	$124.67
United Facility/Professional Professional Modifier Low / Median / High Price $79.04 / $120.01 / $226.37	Professional		$79.04	$120.01	$226.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.11 / $41.88 / $132.62	Professional	26	$32.11	$41.88	$132.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.49 / $60.99 / $134.38	Professional	TC	$28.49	$60.99	$134.38