Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $99.29 / $99.29 / $109.55	Facility	26	$99.29	$99.29	$109.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.46 / $148.08 / $245.30	Professional		$119.46	$148.08	$245.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.64 / $48.09 / $104.67	Professional	26	$42.64	$48.09	$104.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.73 / $107.15 / $196.40	Professional	TC	$76.73	$107.15	$196.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.38 / $50.38 / $50.38	Facility	26	$50.38	$50.38	$50.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.44 / $262.05 / $359.92	Professional		$154.44	$262.05	$359.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.57 / $91.52 / $126.31	Professional	26	$58.57	$91.52	$126.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $110.67 / $172.64 / $236.53	Professional	TC	$110.67	$172.64	$236.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $211.63 / $275.93 / $318.43	Professional		$211.63	$275.93	$318.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $77.15 / $100.49 / $113.15	Professional	26	$77.15	$100.49	$113.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.46 / $174.83 / $205.29	Professional	TC	$134.46	$174.83	$205.29
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $183.52 / $236.16 / $374.51	Professional		$183.52	$236.16	$374.51
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.56 / $82.46 / $138.97	Professional	26	$63.56	$82.46	$138.97
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $84.74 / $127.82 / $235.54	Professional	TC	$84.74	$127.82	$235.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $63.47 / $85.80 / $88.44	Facility	26	$63.47	$85.80	$88.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $52.66 / $75.00 / $96.94	Professional	26	$52.66	$75.00	$96.94
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $107.20 / $159.36 / $259.26	Professional	TC	$107.20	$159.36	$259.26
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $50.38 / $50.38 / $50.38	Facility	26	$50.38	$50.38	$50.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $171.26 / $277.10 / $359.92	Professional		$171.26	$277.10	$359.92
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $59.34 / $91.52 / $126.31	Professional	26	$59.34	$91.52	$126.31
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $110.53 / $178.61 / $239.76	Professional	TC	$110.53	$178.61	$239.76
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 $198.72 / $259.44 / $358.87	Professional		$198.72	$259.44	$358.87
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $70.73 / $87.31 / $124.12	Professional	26	$70.73	$87.31	$124.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $127.98 / $169.47 / $236.12	Professional	TC	$127.98	$169.47	$236.12
United Facility/Professional Professional Modifier Low / Median / High Price $187.30 / $301.58 / $392.55	Professional		$187.30	$301.58	$392.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.81 / $95.50 / $139.36	Professional	26	$66.81	$95.50	$139.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $118.83 / $193.04 / $263.06	Professional	TC	$118.83	$193.04	$263.06