Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.39 / $58.60 / $72.78	Facility	26	$36.39	$58.60	$72.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.06 / $113.30 / $505.00	Professional		$86.06	$113.30	$505.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.64 / $31.15 / $88.00	Professional	26	$24.64	$31.15	$88.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.40 / $76.04 / $185.06	Professional	TC	$61.40	$76.04	$185.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $103.82 / $217.88 / $314.68	Professional		$103.82	$217.88	$314.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.46 / $54.79 / $76.79	Professional	26	$30.46	$54.79	$76.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.56 / $166.47 / $238.96	Professional	TC	$74.56	$166.47	$238.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $204.69 / $238.54 / $290.86	Professional		$204.69	$238.54	$290.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $48.43 / $57.30 / $66.13	Professional	26	$48.43	$57.30	$66.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $155.51 / $181.97 / $224.73	Professional	TC	$155.51	$181.97	$224.73
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $161.40 / $186.32 / $339.51	Professional		$161.40	$186.32	$339.51
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.10 / $53.45 / $81.70	Professional	26	$41.10	$53.45	$81.70
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $129.69 / $161.13 / $257.81	Professional	TC	$129.69	$161.13	$257.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.28 / $50.69 / $52.93	Facility	26	$38.28	$50.69	$52.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $43.85 / $55.70	Professional	26	$31.76	$43.85	$55.70
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $87.70 / $133.65 / $162.81	Professional	TC	$87.70	$133.65	$162.81
Providence Facility/Professional Professional Modifier Low / Median / High Price $164.09 / $235.27 / $310.39	Professional		$164.09	$235.27	$310.39
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $35.11 / $57.17 / $75.72	Professional	26	$35.11	$57.17	$75.72
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $88.05 / $175.02 / $238.05	Professional	TC	$88.05	$175.02	$238.05
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $192.12 / $257.67 / $306.62	Professional		$192.12	$257.67	$306.62
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $48.39 / $63.11 / $74.51	Professional	26	$48.39	$63.11	$74.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $146.53 / $195.06 / $232.11	Professional	TC	$146.53	$195.06	$232.11
United Facility/Professional Professional Modifier Low / Median / High Price $108.78 / $120.37 / $331.79	Professional		$108.78	$120.37	$331.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.15 / $30.76 / $80.80	Professional	26	$28.15	$30.76	$80.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.54 / $87.70 / $251.17	Professional	TC	$78.54	$87.70	$251.17