Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.22 / $320.42 / $328.64	Facility	26	$40.22	$320.42	$328.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.09 / $136.22 / $501.33	Professional		$103.09	$136.22	$501.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.82 / $36.17 / $120.00	Professional	26	$24.82	$36.17	$120.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.34 / $89.16 / $205.18	Professional	TC	$77.34	$89.16	$205.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.35 / $214.41 / $308.66	Professional		$127.35	$214.41	$308.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.46 / $52.37 / $75.11	Professional	26	$32.46	$52.37	$75.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.82 / $165.33 / $233.55	Professional	TC	$93.82	$165.33	$233.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $186.74 / $217.63 / $265.08	Professional		$186.74	$217.63	$265.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.07 / $54.56 / $62.91	Professional	26	$46.07	$54.56	$62.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $139.91 / $163.69 / $202.17	Professional	TC	$139.91	$163.69	$202.17
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $150.44 / $177.10 / $298.89	Professional		$150.44	$177.10	$298.89
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.96 / $50.67 / $77.44	Professional	26	$38.96	$50.67	$77.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $116.89 / $150.47 / $232.36	Professional	TC	$116.89	$150.47	$232.36
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.77 / $48.26 / $51.68	Facility	26	$35.77	$48.26	$51.68
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.02 / $42.48 / $55.12	Professional	26	$33.02	$42.48	$55.12
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $99.96 / $142.80 / $193.20	Professional	TC	$99.96	$142.80	$193.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $177.00 / $224.25 / $282.45	Professional		$177.00	$224.25	$282.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.07 / $53.73 / $70.47	Professional	26	$33.07	$53.73	$70.47
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $100.11 / $168.05 / $219.29	Professional	TC	$100.11	$168.05	$219.29
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $782.93 / $782.93 / $782.93	Facility	26	$782.93	$782.93	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $185.96 / $231.03 / $278.57	Professional		$185.96	$231.03	$278.57
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $46.17 / $56.98 / $69.17	Professional	26	$46.17	$56.98	$69.17
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $139.78 / $175.75 / $209.40	Professional	TC	$139.78	$175.75	$209.40
United Facility/Professional Professional Modifier Low / Median / High Price $127.25 / $213.57 / $309.88	Professional		$127.25	$213.57	$309.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.48 / $50.53 / $75.47	Professional	26	$28.48	$50.53	$75.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.88 / $155.83 / $235.12	Professional	TC	$83.88	$155.83	$235.12