Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $123.03 / $151.36	Facility	26	$79.43	$123.03	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $117.49 / $275.42	Professional		$93.33	$117.49	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $72.44 / $263.03	Professional	26	$57.54	$72.44	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $46.77 / $87.10	Professional	TC	$30.20	$46.77	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $199.53 / $309.03	Professional		$102.33	$199.53	$309.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $112.20 / $173.78	Professional	26	$70.79	$112.20	$173.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $83.18 / $134.90	Professional	TC	$30.20	$83.18	$134.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $223.87 / $275.42	Professional		$181.97	$223.87	$275.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $125.89 / $154.88	Professional	26	$100.00	$125.89	$154.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $97.72 / $123.03	Professional	TC	$83.18	$97.72	$123.03
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $112.20 / $123.03	Facility	26	$81.28	$112.20	$123.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $169.82 / $257.04	Professional		$117.49	$169.82	$257.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $112.20 / $154.88	Professional	26	$69.18	$112.20	$154.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $81.28 / $117.49	Professional	TC	$52.48	$81.28	$117.49
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $117.49 / $123.03	Facility	26	$97.72	$117.49	$123.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $102.33 / $128.82	Professional	26	$72.44	$102.33	$128.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $48.98 / $72.44	Professional	TC	$32.36	$48.98	$72.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $204.17 / $281.84	Professional		$123.03	$204.17	$281.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $114.82 / $158.49	Professional	26	$75.86	$114.82	$158.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $66.07 / $120.23	Professional	TC	$34.67	$66.07	$120.23
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $125.89 / $125.89	Facility	26	$125.89	$125.89	$125.89
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $213.80 / $281.84	Professional		$134.90	$213.80	$281.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $123.03 / $158.49	Professional	26	$75.86	$123.03	$158.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $93.33 / $123.03	Professional	TC	$53.70	$93.33	$123.03
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $190.55 / $275.42	Professional		$125.89	$190.55	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $125.89 / $173.78	Professional	26	$79.43	$125.89	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $67.61 / $114.82	Professional	TC	$42.66	$67.61	$114.82