Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.93 / $122.43 / $148.46	Facility	26	$80.93	$122.43	$148.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.18 / $128.13 / $396.00	Professional		$93.18	$128.13	$396.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.90 / $73.09 / $268.00	Professional	26	$61.90	$73.09	$268.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.51 / $48.04 / $84.04	Professional	TC	$30.51	$48.04	$84.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.22 / $203.23 / $308.77	Professional		$104.22	$203.23	$308.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.04 / $121.94 / $184.17	Professional	26	$74.04	$121.94	$184.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.03 / $73.03 / $134.72	Professional	TC	$30.03	$73.03	$134.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.75 / $231.58 / $277.83	Professional		$190.75	$231.58	$277.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $109.04 / $128.38 / $154.04	Professional	26	$109.04	$128.38	$154.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.70 / $100.16 / $123.76	Professional	TC	$81.70	$100.16	$123.76
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $131.58 / $165.47 / $272.48	Professional		$131.58	$165.47	$272.48
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.73 / $103.64 / $181.98	Professional	26	$77.73	$103.64	$181.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.51 / $80.18 / $141.30	Professional	TC	$58.51	$80.18	$141.30
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $87.22 / $117.84 / $122.40	Facility	26	$87.22	$117.84	$122.40
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $75.18 / $102.51 / $128.88	Professional	26	$75.18	$102.51	$128.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $32.34 / $49.13 / $82.62	Professional	TC	$32.34	$49.13	$82.62
Providence Facility/Professional Professional Modifier Low / Median / High Price $133.02 / $207.18 / $282.48	Professional		$133.02	$207.18	$282.48
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $74.04 / $118.89 / $165.11	Professional	26	$74.04	$118.89	$165.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.65 / $67.54 / $126.28	Professional	TC	$28.65	$67.54	$126.28
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 $126.56 / $215.37 / $287.66	Professional		$126.56	$215.37	$287.66
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $72.41 / $125.17 / $164.63	Professional	26	$72.41	$125.17	$164.63
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $92.64 / $122.32	Professional	TC	$53.70	$92.64	$122.32
United Facility/Professional Professional Modifier Low / Median / High Price $136.91 / $189.42 / $290.43	Professional		$136.91	$189.42	$290.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $86.40 / $123.91 / $184.32	Professional	26	$86.40	$123.91	$184.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.43 / $67.67 / $120.02	Professional	TC	$43.43	$67.67	$120.02