Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $125.41 / $125.41 / $136.63	Facility	26	$125.41	$125.41	$136.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.62 / $124.41 / $363.81	Professional		$83.62	$124.41	$363.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.40 / $74.11 / $244.93	Professional	26	$56.40	$74.11	$244.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.89 / $44.93 / $78.37	Professional	TC	$26.89	$44.93	$78.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.97 / $188.25 / $286.16	Professional		$92.97	$188.25	$286.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.02 / $111.81 / $168.73	Professional	26	$66.02	$111.81	$168.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.33 / $67.83 / $125.87	Professional	TC	$26.33	$67.83	$125.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $176.61 / $214.44 / $257.26	Professional		$176.61	$214.44	$257.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $100.40 / $118.22 / $141.83	Professional	26	$100.40	$118.22	$141.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $76.20 / $93.42 / $115.43	Professional	TC	$76.20	$93.42	$115.43
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $119.34 / $150.80 / $252.40	Professional		$119.34	$150.80	$252.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.56 / $98.14 / $167.73	Professional	26	$70.56	$98.14	$167.73
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.58 / $74.80 / $132.15	Professional	TC	$54.58	$74.80	$132.15
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $79.87 / $108.50 / $111.22	Facility	26	$79.87	$108.50	$111.22
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $65.53 / $96.82 / $124.29	Professional	26	$65.53	$96.82	$124.29
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.53 / $42.60 / $75.20	Professional	TC	$26.53	$42.60	$75.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $123.25 / $191.75 / $262.24	Professional		$123.25	$191.75	$262.24
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.95 / $109.26 / $151.18	Professional	26	$66.95	$109.26	$151.18
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $26.33 / $60.25 / $117.96	Professional	TC	$26.33	$60.25	$117.96
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 $117.41 / $196.62 / $266.11	Professional		$117.41	$196.62	$266.11
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $66.34 / $115.27 / $150.83	Professional	26	$66.34	$115.27	$150.83
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $50.23 / $86.65 / $114.40	Professional	TC	$50.23	$86.65	$114.40
United Facility/Professional Professional Modifier Low / Median / High Price $124.80 / $175.26 / $268.73	Professional		$124.80	$175.26	$268.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.69 / $118.58 / $169.99	Professional	26	$79.69	$118.58	$169.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.43 / $63.36 / $111.59	Professional	TC	$40.43	$63.36	$111.59