Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $108.66 / $108.66 / $205.29	Facility		$108.66	$108.66	$205.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.66 / $67.79 / $114.88	Professional		$45.66	$67.79	$114.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $25.12 / $52.81	Professional	26	$17.07	$25.12	$52.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.51 / $46.07 / $73.06	Professional	TC	$26.51	$46.07	$73.06
Cigna Facility/Professional Facility Modifier Low / Median / High Price $76.23 / $76.23 / $76.23	Facility		$76.23	$76.23	$76.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.19 / $64.75 / $118.47	Professional		$32.19	$64.75	$118.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.33 / $24.25 / $37.53	Professional	26	$13.33	$24.25	$37.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.23 / $40.50 / $75.84	Professional	TC	$17.23	$40.50	$75.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.95 / $138.66 / $197.66	Professional		$66.95	$138.66	$197.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.82 / $43.12 / $61.47	Professional	26	$20.82	$43.12	$61.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.13 / $95.55 / $136.19	Professional	TC	$46.13	$95.55	$136.19
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $42.36 / $82.78 / $172.26	Facility		$42.36	$82.78	$172.26
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $101.22 / $122.95 / $222.81	Professional		$101.22	$122.95	$222.81
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.70 / $49.42 / $68.98	Professional	26	$34.70	$49.42	$68.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.40 / $77.39 / $153.83	Professional	TC	$35.40	$77.39	$153.83
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $73.70 / $118.59 / $141.44	Facility		$73.70	$118.59	$141.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $31.98 / $43.12 / $49.78	Facility	26	$31.98	$43.12	$49.78
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $25.73 / $33.65 / $45.54	Professional	26	$25.73	$33.65	$45.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $46.45 / $62.71 / $100.20	Professional	TC	$46.45	$62.71	$100.20
Providence Facility/Professional Facility Modifier Low / Median / High Price $59.02 / $152.72 / $199.82	Facility		$59.02	$152.72	$199.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $66.64 / $128.05 / $189.17	Professional		$66.64	$128.05	$189.17
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.33 / $24.25 / $41.76	Professional	26	$13.33	$24.25	$41.76
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $22.49 / $40.50 / $82.61	Professional	TC	$22.49	$40.50	$82.61
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $138.51 / $138.51 / $139.30	Facility		$138.51	$138.51	$139.30
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $117.90 / $128.61 / $220.01	Professional		$117.90	$128.61	$220.01
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $44.31 / $69.42	Professional	26	$38.90	$44.31	$69.42
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $79.00 / $83.16 / $150.59	Professional	TC	$79.00	$83.16	$150.59
United Facility/Professional Professional Modifier Low / Median / High Price $37.90 / $63.16 / $207.64	Professional		$37.90	$63.16	$207.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.08 / $14.24 / $68.52	Professional	26	$14.08	$14.24	$68.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.82 / $36.86 / $139.12	Professional	TC	$23.82	$36.86	$139.12