Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.03 / $135.69 / $306.64	Facility	26	$94.03	$135.69	$306.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $137.58 / $210.43 / $747.00	Professional		$137.58	$210.43	$747.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.92 / $137.25 / $886.10	Professional	26	$56.92	$137.25	$886.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.90 / $95.45 / $296.23	Professional	TC	$83.90	$95.45	$296.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.94 / $277.61 / $370.73	Professional		$199.94	$277.61	$370.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.92 / $128.19 / $173.48	Professional	26	$90.92	$128.19	$173.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.02 / $154.13 / $193.73	Professional	TC	$109.02	$154.13	$193.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $252.17 / $296.64 / $341.56	Professional		$252.17	$296.64	$341.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $117.02 / $140.28 / $158.50	Professional	26	$117.02	$140.28	$158.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $135.15 / $155.91 / $183.06	Professional	TC	$135.15	$155.91	$183.06
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $202.16 / $229.32 / $379.20	Professional		$202.16	$229.32	$379.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.14 / $121.71 / $193.09	Professional	26	$97.14	$121.71	$193.09
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $105.68 / $150.52 / $210.08	Professional	TC	$105.68	$150.52	$210.08
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $88.47 / $116.58 / $120.60	Facility	26	$88.47	$116.58	$120.60
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $92.92 / $92.92 / $92.92	Professional		$92.92	$92.92	$92.92
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $79.26 / $103.09 / $128.41	Professional	26	$79.26	$103.09	$128.41
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $93.97 / $131.32 / $171.61	Professional	TC	$93.97	$131.32	$171.61
Providence Facility/Professional Professional Modifier Low / Median / High Price $217.36 / $292.29 / $368.93	Professional		$217.36	$292.29	$368.93
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $79.73 / $116.58 / $166.38	Professional	26	$79.73	$116.58	$166.38
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $85.16 / $148.07 / $193.73	Professional	TC	$85.16	$148.07	$193.73
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 $234.99 / $292.74 / $353.42	Professional		$234.99	$292.74	$353.42
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $109.19 / $139.96 / $169.60	Professional	26	$109.19	$139.96	$169.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $122.22 / $159.82 / $183.82	Professional	TC	$122.22	$159.82	$183.82
United Facility/Professional Professional Modifier Low / Median / High Price $162.85 / $216.00 / $386.43	Professional		$162.85	$216.00	$386.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.81 / $81.01 / $190.45	Professional	26	$75.81	$81.01	$190.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $84.35 / $116.56 / $206.39	Professional	TC	$84.35	$116.56	$206.39