Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.00 / $80.83 / $165.29	Facility	26	$61.00	$80.83	$165.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $122.02 / $164.72 / $524.25	Professional		$122.02	$164.72	$524.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.20 / $38.01 / $173.25	Professional	26	$29.20	$38.01	$173.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $104.76 / $127.51 / $323.93	Professional	TC	$104.76	$127.51	$323.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $161.58 / $320.38 / $434.76	Professional		$161.58	$320.38	$434.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.07 / $74.40 / $104.97	Professional	26	$41.07	$74.40	$104.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.25 / $241.99 / $331.76	Professional	TC	$123.25	$241.99	$331.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $280.06 / $326.38 / $397.88	Professional		$280.06	$326.38	$397.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.36 / $79.69 / $91.99	Professional	26	$67.36	$79.69	$91.99
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $211.70 / $247.71 / $305.92	Professional	TC	$211.70	$247.71	$305.92
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $229.00 / $255.02 / $453.42	Professional		$229.00	$255.02	$453.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.11 / $70.59 / $113.52	Professional	26	$57.11	$70.59	$113.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $176.67 / $218.42 / $351.19	Professional	TC	$176.67	$218.42	$351.19
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $52.92 / $70.48 / $73.03	Facility	26	$52.92	$70.48	$73.03
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $78.25 / $78.25	Professional		$78.25	$78.25	$78.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $43.42 / $60.99 / $75.87	Professional	26	$43.42	$60.99	$75.87
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $137.47 / $183.12 / $235.98	Professional	TC	$137.47	$183.12	$235.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $257.83 / $326.33 / $434.48	Professional		$257.83	$326.33	$434.48
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.71 / $78.11 / $104.24	Professional	26	$47.71	$78.11	$104.24
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $145.57 / $251.74 / $330.67	Professional	TC	$145.57	$251.74	$330.67
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 $274.91 / $354.40 / $422.92	Professional		$274.91	$354.40	$422.92
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.54 / $85.89 / $101.38	Professional	26	$65.54	$85.89	$101.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $208.49 / $274.27 / $321.20	Professional	TC	$208.49	$274.27	$321.20
United Facility/Professional Professional Modifier Low / Median / High Price $156.55 / $172.21 / $462.07	Professional		$156.55	$172.21	$462.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.69 / $42.56 / $112.50	Professional	26	$38.69	$42.56	$112.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $119.47 / $129.65 / $351.21	Professional	TC	$119.47	$129.65	$351.21