Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $186.21 / $199.53	Facility	26	$104.71	$186.21	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $173.78 / $436.52	Professional		$131.83	$173.78	$436.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $85.11 / $134.90	Professional	26	$74.13	$85.11	$134.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $83.18 / $147.91	Professional	TC	$56.23	$83.18	$147.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $295.12 / $467.74	Professional		$165.96	$295.12	$467.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $154.88 / $229.09	Professional	26	$89.13	$154.88	$229.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $154.88 / $251.19	Professional	TC	$70.79	$154.88	$251.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $354.81 / $416.87	Professional		$288.40	$354.81	$416.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $173.78 / $208.93	Professional	26	$144.54	$173.78	$208.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $181.97 / $208.93	Professional	TC	$144.54	$181.97	$208.93
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $302.00 / $407.38	Professional		$181.97	$302.00	$407.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $151.36 / $208.93	Professional	26	$85.11	$151.36	$208.93
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $154.88 / $223.87	Professional	TC	$56.23	$154.88	$223.87
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $154.88 / $158.49	Facility	26	$128.82	$154.88	$158.49
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $134.90 / $165.96	Professional	26	$95.50	$134.90	$165.96
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $120.23 / $181.97	Professional	TC	$69.18	$120.23	$181.97
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $19.50 / $89.13 / $128.82	Facility	26	$19.50	$89.13	$128.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $323.59 / $446.68	Professional		$218.78	$323.59	$446.68
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $154.88 / $223.87	Professional	26	$102.33	$154.88	$223.87
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $162.18 / $234.42	Professional	TC	$79.43	$162.18	$234.42
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $354.81 / $354.81 / $354.81	Facility	26	$354.81	$354.81	$354.81
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $331.13 / $436.52	Professional		$239.88	$331.13	$436.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $158.49 / $213.80	Professional	26	$128.82	$158.49	$213.80
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $169.82 / $218.78	Professional	TC	$114.82	$169.82	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $331.13 / $501.19	Professional		$162.18	$331.13	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $162.18 / $239.88	Professional	26	$93.33	$162.18	$239.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $169.82 / $257.04	Professional	TC	$72.44	$169.82	$257.04