Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.33 / $47.98 / $146.81	Facility	26	$39.33	$47.98	$146.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.37 / $109.95 / $244.87	Professional		$88.37	$109.95	$244.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.98 / $29.99 / $89.86	Professional	26	$23.98	$29.99	$89.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.37 / $73.83 / $181.74	Professional	TC	$64.37	$73.83	$181.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.83 / $140.88 / $202.29	Professional		$45.83	$140.88	$202.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.27 / $37.40 / $53.99	Professional	26	$13.27	$37.40	$53.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.61 / $103.49 / $155.04	Professional	TC	$32.61	$103.49	$155.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.52 / $293.82 / $323.87	Professional		$123.52	$293.82	$323.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.46 / $70.95 / $78.22	Professional	26	$31.46	$70.95	$78.22
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $92.06 / $222.86 / $245.65	Professional	TC	$92.06	$222.86	$245.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $206.55 / $226.58 / $410.59	Professional		$206.55	$226.58	$410.59
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.31 / $57.38 / $103.98	Professional	26	$52.31	$57.38	$103.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.24 / $169.20 / $306.61	Professional	TC	$154.24	$169.20	$306.61
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $48.02 / $65.17 / $68.34	Facility	26	$48.02	$65.17	$68.34
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $43.11 / $53.89 / $73.80	Professional	26	$43.11	$53.89	$73.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $126.16 / $166.10 / $204.75	Professional	TC	$126.16	$166.10	$204.75
Providence Facility/Professional Professional Modifier Low / Median / High Price $140.88 / $264.55 / $374.44	Professional		$140.88	$264.55	$374.44
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $37.40 / $53.99	Professional	26	$14.45	$37.40	$53.99
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $39.59 / $103.49 / $177.19	Professional	TC	$39.59	$103.49	$177.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $243.59 / $282.22 / $427.20	Professional		$243.59	$282.22	$427.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $59.25 / $76.14 / $104.66	Professional	26	$59.25	$76.14	$104.66
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $184.34 / $214.05 / $322.54	Professional	TC	$184.34	$214.05	$322.54
United Facility/Professional Professional Modifier Low / Median / High Price $58.64 / $84.23 / $428.98	Professional		$58.64	$84.23	$428.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.39 / $21.65 / $72.18	Professional	26	$16.39	$21.65	$72.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.25 / $62.58 / $191.46	Professional	TC	$42.25	$62.58	$191.46