Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $154.88 / $186.21	Facility	26	$112.20	$154.88	$186.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $177.83 / $588.84	Professional		$128.82	$177.83	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $85.11 / $251.19	Professional	26	$53.70	$85.11	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $109.65 / $229.09	Professional	TC	$66.07	$109.65	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $281.84 / $407.38	Professional		$158.49	$281.84	$407.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $120.23 / $194.98	Professional	26	$58.88	$120.23	$194.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $151.36 / $239.88	Professional	TC	$74.13	$151.36	$239.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $263.03 / $316.23	Professional		$204.17	$263.03	$316.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $141.25 / $165.96	Professional	26	$109.65	$141.25	$165.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $120.23 / $154.88	Professional	TC	$97.72	$120.23	$154.88
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $138.04 / $186.21	Facility	26	$85.11	$138.04	$186.21
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $263.03 / $467.74	Professional		$173.78	$263.03	$467.74
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $134.90 / $204.17	Professional	26	$72.44	$134.90	$204.17
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $131.83 / $239.88	Professional	TC	$91.20	$131.83	$239.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $131.83 / $141.25	Facility	26	$93.33	$131.83	$141.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $102.33 / $134.90	Professional	26	$74.13	$102.33	$134.90
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $123.03 / $190.55	Professional	TC	$87.10	$123.03	$190.55
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $112.20	Facility	26	$16.98	$79.43	$112.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $295.12 / $398.11	Professional		$213.80	$295.12	$398.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $128.82 / $194.98	Professional	26	$89.13	$128.82	$194.98
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $151.36 / $218.78	Professional	TC	$95.50	$151.36	$218.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $295.12 / $380.19	Professional		$229.09	$295.12	$380.19
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $144.54 / $186.21	Professional	26	$100.00	$144.54	$186.21
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 $107.15 / $199.53 / $371.54	Professional		$107.15	$199.53	$371.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $75.86 / $181.97	Professional	26	$50.12	$75.86	$181.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $102.33 / $223.87	Professional	TC	$57.54	$102.33	$223.87