Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.16 / $93.16 / $100.57	Facility	26	$93.16	$93.16	$100.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $65.54 / $94.12 / $293.89	Professional		$65.54	$94.12	$293.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.00 / $51.62 / $135.30	Professional	26	$42.00	$51.62	$135.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.28 / $39.89 / $71.43	Professional	TC	$23.28	$39.89	$71.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.64 / $153.59 / $233.06	Professional		$74.64	$153.59	$233.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.49 / $82.48 / $124.49	Professional	26	$49.49	$82.48	$124.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.01 / $62.22 / $115.06	Professional	TC	$24.01	$62.22	$115.06
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $143.55 / $174.92 / $209.86	Professional		$143.55	$174.92	$209.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $74.06 / $87.19 / $104.60	Professional	26	$74.06	$87.19	$104.60
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $69.48 / $85.17 / $105.25	Professional	TC	$69.48	$85.17	$105.25
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $92.82 / $120.64 / $205.23	Professional		$92.82	$120.64	$205.23
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.84 / $72.41 / $125.04	Professional	26	$52.84	$72.41	$125.04
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.79 / $68.23 / $120.97	Professional	TC	$49.79	$68.23	$120.97
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $58.80 / $80.04 / $83.64	Facility	26	$58.80	$80.04	$83.64
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $50.82 / $74.86 / $89.54	Professional	26	$50.82	$74.86	$89.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $27.13 / $37.70 / $72.89	Professional	TC	$27.13	$37.70	$72.89
Providence Facility/Professional Professional Modifier Low / Median / High Price $97.24 / $157.30 / $215.36	Professional		$97.24	$157.30	$215.36
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $49.71 / $81.12 / $112.24	Professional	26	$49.71	$81.12	$112.24
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $24.01 / $55.27 / $107.79	Professional	TC	$24.01	$55.27	$107.79
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $127.19 / $127.19 / $127.19	Facility	26	$127.19	$127.19	$127.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $96.32 / $161.29 / $217.38	Professional		$96.32	$161.29	$217.38
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $48.95 / $84.86 / $111.91	Professional	26	$48.95	$84.86	$111.91
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $45.98 / $79.31 / $104.72	Professional	TC	$45.98	$79.31	$104.72
United Facility/Professional Professional Modifier Low / Median / High Price $95.04 / $139.37 / $224.32	Professional		$95.04	$139.37	$224.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.08 / $86.62 / $126.10	Professional	26	$58.08	$86.62	$126.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.54 / $59.83 / $114.54	Professional	TC	$36.54	$59.83	$114.54