Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.22 / $117.22 / $147.34	Facility	26	$117.22	$117.22	$147.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.21 / $191.59 / $312.55	Professional		$119.21	$191.59	$312.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.35 / $72.13 / $151.32	Professional	26	$59.35	$72.13	$151.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.31 / $119.94 / $190.84	Professional	TC	$59.31	$119.94	$190.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $160.94 / $261.02 / $407.00	Professional		$160.94	$261.02	$407.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.91 / $124.44 / $181.08	Professional	26	$67.91	$124.44	$181.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.01 / $135.84 / $221.84	Professional	TC	$81.01	$135.84	$221.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $224.34 / $261.44 / $313.01	Professional		$224.34	$261.44	$313.01
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $111.45 / $131.75 / $152.19	Professional	26	$111.45	$131.75	$152.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $111.29 / $130.22 / $160.84	Professional	TC	$111.29	$130.22	$160.84
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $190.29 / $246.33 / $351.75	Professional		$190.29	$246.33	$351.75
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.93 / $113.82 / $186.73	Professional	26	$93.93	$113.82	$186.73
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $92.86 / $121.48 / $184.60	Professional	TC	$92.86	$121.48	$184.60
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $85.26 / $116.52 / $119.00	Facility	26	$85.26	$116.52	$119.00
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $70.75 / $100.19 / $127.75	Professional	26	$70.75	$100.19	$127.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $71.15 / $107.57 / $196.47	Professional	TC	$71.15	$107.57	$196.47
Providence Facility/Professional Professional Modifier Low / Median / High Price $212.66 / $267.73 / $343.49	Professional		$212.66	$267.73	$343.49
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $78.37 / $127.52 / $169.97	Professional	26	$78.37	$127.52	$169.97
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $84.80 / $137.33 / $209.93	Professional	TC	$84.80	$137.33	$209.93
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $219.08 / $279.95 / $329.82	Professional		$219.08	$279.95	$329.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $109.12 / $137.37 / $164.87	Professional	26	$109.12	$137.37	$164.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $108.91 / $139.16 / $168.31	Professional	TC	$108.91	$139.16	$168.31
United Facility/Professional Professional Modifier Low / Median / High Price $153.06 / $259.27 / $384.06	Professional		$153.06	$259.27	$384.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.20 / $119.01 / $180.89	Professional	26	$66.20	$119.01	$180.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.34 / $123.11 / $190.93	Professional	TC	$74.34	$123.11	$190.93