Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.19 / $113.56 / $253.98	Facility	26	$78.19	$113.56	$253.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.59 / $115.83 / $421.44	Professional		$95.59	$115.83	$421.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.96 / $53.00 / $191.52	Professional	26	$40.96	$53.00	$191.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.64 / $61.87 / $120.93	Professional	TC	$54.64	$61.87	$120.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.86 / $216.29 / $270.24	Professional		$144.86	$216.29	$270.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.53 / $106.20 / $137.31	Professional	26	$71.53	$106.20	$137.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.88 / $101.27 / $132.91	Professional	TC	$69.88	$101.27	$132.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $188.99 / $222.82 / $255.99	Professional		$188.99	$222.82	$255.99
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $96.93 / $116.29 / $131.29	Professional	26	$96.93	$116.29	$131.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $92.06 / $106.22 / $124.70	Professional	TC	$92.06	$106.22	$124.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $136.16 / $167.44 / $284.64	Professional		$136.16	$167.44	$284.64
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $80.59 / $100.75 / $151.47	Professional	26	$80.59	$100.75	$151.47
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.06 / $102.62 / $183.95	Professional	TC	$72.06	$102.62	$183.95
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $68.11 / $93.80 / $99.83	Facility	26	$68.11	$93.80	$99.83
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $59.83 / $59.83 / $59.83	Professional		$59.83	$59.83	$59.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $56.00 / $84.00 / $102.20	Professional	26	$56.00	$84.00	$102.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $49.85 / $78.29 / $102.08	Professional	TC	$49.85	$78.29	$102.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $151.04 / $210.14 / $274.51	Professional		$151.04	$210.14	$274.51
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.14 / $96.14 / $137.05	Professional	26	$66.14	$96.14	$137.05
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $57.98 / $97.65 / $126.90	Professional	TC	$57.98	$97.65	$126.90
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,088.88 / $1,088.88 / $1,088.88	Facility	26	$1,088.88	$1,088.88	$1,088.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $167.58 / $219.75 / $265.30	Professional		$167.58	$219.75	$265.30
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $89.18 / $115.70 / $141.18	Professional	26	$89.18	$115.70	$141.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $79.34 / $102.75 / $124.12	Professional	TC	$79.34	$102.75	$124.12
United Facility/Professional Professional Modifier Low / Median / High Price $115.89 / $123.81 / $297.88	Professional		$115.89	$123.81	$297.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.35 / $65.41 / $154.36	Professional	26	$61.35	$65.41	$154.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.35 / $97.66 / $145.40	Professional	TC	$54.35	$97.66	$145.40