Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $72.44 / $83.18	Facility	26	$53.70	$72.44	$83.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $117.49 / $309.03	Professional		$91.20	$117.49	$309.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $42.66 / $93.33	Professional	26	$28.18	$42.66	$93.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $81.28 / $158.49	Professional	TC	$61.66	$81.28	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $208.93 / $309.03	Professional		$114.82	$208.93	$309.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $61.66 / $95.50	Professional	26	$37.15	$61.66	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $147.91 / $223.87	Professional	TC	$79.43	$147.91	$223.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $234.42 / $295.12	Professional		$204.17	$234.42	$295.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $70.79 / $85.11	Professional	26	$60.26	$70.79	$85.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $165.96 / $208.93	Professional	TC	$141.25	$165.96	$208.93
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $66.07 / $67.61	Facility	26	$64.57	$66.07	$67.61
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $218.78 / $338.84	Professional		$120.23	$218.78	$338.84
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $67.61 / $97.72	Professional	26	$35.48	$67.61	$97.72
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $154.88 / $223.87	Professional	TC	$81.28	$154.88	$223.87
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $64.57 / $66.07	Facility	26	$53.70	$64.57	$66.07
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $53.70 / $66.07	Professional	26	$38.02	$53.70	$66.07
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $147.91 / $154.88	Professional	TC	$120.23	$147.91	$154.88
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $8.13 / $38.02 / $53.70	Facility	26	$8.13	$38.02	$53.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $239.88 / $323.59	Professional		$181.97	$239.88	$323.59
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $72.44 / $100.00	Professional	26	$44.67	$72.44	$100.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $165.96 / $245.47	Professional	TC	$100.00	$165.96	$245.47
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $616.60 / $616.60 / $616.60	Facility	26	$616.60	$616.60	$616.60
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $223.87 / $295.12	Professional		$186.21	$223.87	$295.12
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $70.79 / $91.20	Professional	26	$58.88	$70.79	$91.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $158.49 / $208.93	Professional	TC	$125.89	$158.49	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $134.90 / $288.40	Professional		$107.15	$134.90	$288.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $43.65 / $91.20	Professional	26	$34.67	$43.65	$91.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $93.33 / $204.17	Professional	TC	$74.13	$93.33	$204.17