Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $156.77 / $344.17	Facility	26	$105.78	$156.77	$344.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $139.18 / $179.34 / $727.00	Professional		$139.18	$179.34	$727.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.54 / $86.00 / $303.86	Professional	26	$52.54	$86.00	$303.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.09 / $113.91 / $285.00	Professional	TC	$71.09	$113.91	$285.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.31 / $79.31 / $79.31	Facility	26	$79.31	$79.31	$79.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $174.31 / $289.85 / $410.07	Professional		$174.31	$289.85	$410.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.29 / $135.74 / $201.59	Professional	26	$69.29	$135.74	$201.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $99.79 / $154.11 / $223.88	Professional	TC	$99.79	$154.11	$223.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $241.62 / $293.47 / $335.67	Professional		$241.62	$293.47	$335.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $130.44 / $156.94 / $176.70	Professional	26	$130.44	$156.94	$176.70
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $113.12 / $135.41 / $158.97	Professional	TC	$113.12	$135.41	$158.97
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $197.68 / $239.12 / $426.56	Professional		$197.68	$239.12	$426.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $109.94 / $145.25 / $218.55	Professional	26	$109.94	$145.25	$218.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $91.81 / $137.10 / $219.60	Professional	TC	$91.81	$137.10	$219.60
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $84.42 / $125.42 / $140.69	Facility	26	$84.42	$125.42	$140.69
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $75.51 / $97.44 / $132.16	Professional	26	$75.51	$97.44	$132.16
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $86.83 / $118.00 / $196.48	Professional	TC	$86.83	$118.00	$196.48
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.31 / $79.31 / $79.31	Facility	26	$79.31	$79.31	$79.31
Providence Facility/Professional Professional Modifier Low / Median / High Price $215.33 / $318.02 / $404.49	Professional		$215.33	$318.02	$404.49
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $86.20 / $142.91 / $201.59	Professional	26	$86.20	$142.91	$201.59
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $98.75 / $161.78 / $217.35	Professional	TC	$98.75	$161.78	$217.35
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $249.64 / $313.93 / $401.74	Professional		$249.64	$313.93	$401.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $112.91 / $152.26 / $197.08	Professional	26	$112.91	$152.26	$197.08
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $129.28 / $164.09 / $204.66	Professional	TC	$129.28	$164.09	$204.66
United Facility/Professional Professional Modifier Low / Median / High Price $107.13 / $206.64 / $451.09	Professional		$107.13	$206.64	$451.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.78 / $95.34 / $217.06	Professional	26	$49.78	$95.34	$217.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.54 / $93.54 / $223.76	Professional	TC	$60.54	$93.54	$223.76