Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $179.46 / $179.46 / $198.98	Facility	26	$179.46	$179.46	$198.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.08 / $160.87 / $567.67	Professional		$130.08	$160.87	$567.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.01 / $85.60 / $124.46	Professional	26	$75.01	$85.60	$124.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.03 / $79.09 / $141.40	Professional	TC	$55.03	$79.09	$141.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.04 / $91.04 / $91.04	Facility	26	$91.04	$91.04	$91.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $192.36 / $334.76 / $471.50	Professional		$192.36	$334.76	$471.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.51 / $162.63 / $227.90	Professional	26	$101.51	$162.63	$227.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.76 / $174.94 / $250.61	Professional	TC	$87.76	$174.94	$250.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $276.20 / $360.14 / $413.87	Professional		$276.20	$360.14	$413.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $139.91 / $182.42 / $205.81	Professional	26	$139.91	$182.42	$205.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $136.29 / $177.21 / $208.06	Professional	TC	$136.29	$177.21	$208.06
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $197.12 / $286.44 / $469.56	Professional		$197.12	$286.44	$469.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $117.90 / $143.13 / $251.44	Professional	26	$117.90	$143.13	$251.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $55.80 / $131.00 / $238.72	Professional	TC	$55.80	$131.00	$238.72
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $114.34 / $156.63 / $159.46	Facility	26	$114.34	$156.63	$159.46
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $95.68 / $132.81 / $164.27	Professional	26	$95.68	$132.81	$164.27
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $71.91 / $120.32 / $176.64	Professional	TC	$71.91	$120.32	$176.64
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $91.04 / $91.04 / $91.04	Facility	26	$91.04	$91.04	$91.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $217.02 / $345.74 / $456.77	Professional		$217.02	$345.74	$456.77
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $103.53 / $166.46 / $227.90	Professional	26	$103.53	$166.46	$227.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $102.60 / $182.94 / $254.06	Professional	TC	$102.60	$182.94	$254.06
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $354.01 / $354.01 / $354.01	Facility	26	$354.01	$354.01	$354.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $245.73 / $331.18 / $453.85	Professional		$245.73	$331.18	$453.85
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $127.98 / $157.96 / $224.56	Professional	26	$127.98	$157.96	$224.56
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $124.15 / $175.44 / $229.30	Professional	TC	$124.15	$175.44	$229.30
United Facility/Professional Professional Modifier Low / Median / High Price $243.81 / $340.91 / $503.38	Professional		$243.81	$340.91	$503.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.63 / $172.04 / $249.79	Professional	26	$120.63	$172.04	$249.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.18 / $189.39 / $257.47	Professional	TC	$123.18	$189.39	$257.47