Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $76.17 / $76.17 / $84.43	Facility	26	$76.17	$76.17	$84.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $113.56 / $352.00	Professional		$64.31	$113.56	$352.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.26 / $36.35 / $84.99	Professional	26	$31.26	$36.35	$84.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.03 / $67.50 / $127.53	Professional	TC	$33.03	$67.50	$127.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.61 / $38.61 / $38.61	Facility	26	$38.61	$38.61	$38.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.47 / $197.09 / $288.16	Professional		$97.47	$197.09	$288.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.15 / $68.59 / $94.80	Professional	26	$43.15	$68.59	$94.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.22 / $134.38 / $198.47	Professional	TC	$53.22	$134.38	$198.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $182.54 / $238.00 / $275.27	Professional		$182.54	$238.00	$275.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.57 / $77.67 / $87.60	Professional	26	$59.57	$77.67	$87.60
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $122.95 / $159.84 / $187.68	Professional	TC	$122.95	$159.84	$187.68
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $106.72 / $162.24 / $306.48	Professional		$106.72	$162.24	$306.48
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.01 / $61.44 / $107.16	Professional	26	$49.01	$61.44	$107.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.70 / $118.19 / $215.36	Professional	TC	$29.70	$118.19	$215.36
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $48.02 / $65.66 / $67.67	Facility	26	$48.02	$65.66	$67.67
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $40.60 / $57.82 / $71.54	Professional	26	$40.60	$57.82	$71.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $46.00 / $80.80 / $133.88	Professional	TC	$46.00	$80.80	$133.88
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $38.61 / $38.61 / $38.61	Facility	26	$38.61	$38.61	$38.61
Providence Facility/Professional Professional Modifier Low / Median / High Price $129.01 / $211.43 / $286.62	Professional		$129.01	$211.43	$286.62
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.10 / $70.84 / $94.80	Professional	26	$44.10	$70.84	$94.80
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $53.22 / $138.90 / $198.47	Professional	TC	$53.22	$138.90	$198.47
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $459.43 / $459.43 / $459.43	Facility	26	$459.43	$459.43	$459.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $150.54 / $209.95 / $298.45	Professional		$150.54	$209.95	$298.45
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $54.54 / $67.31 / $95.70	Professional	26	$54.54	$67.31	$95.70
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $93.94 / $142.63 / $202.76	Professional	TC	$93.94	$142.63	$202.76
United Facility/Professional Professional Modifier Low / Median / High Price $143.63 / $183.54 / $286.86	Professional		$143.63	$183.54	$286.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.42 / $70.84 / $106.47	Professional	26	$51.42	$70.84	$106.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.68 / $115.04 / $225.53	Professional	TC	$85.68	$115.04	$225.53