Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $83.18 / $91.20	Facility	26	$57.54	$83.18	$91.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $165.96 / $524.81	Professional		$112.20	$165.96	$524.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $39.81 / $165.96	Professional	26	$28.18	$39.81	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $125.89 / $263.03	Professional	TC	$91.20	$125.89	$263.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $281.84 / $426.58	Professional		$144.54	$281.84	$426.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $67.61 / $100.00	Professional	26	$38.02	$67.61	$100.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $213.80 / $331.13	Professional	TC	$102.33	$213.80	$331.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $309.03 / $380.19	Professional		$245.47	$309.03	$380.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $72.44 / $87.10	Professional	26	$56.23	$72.44	$87.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $234.42 / $295.12	Professional	TC	$190.55	$234.42	$295.12
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $83.18 / $91.20	Facility	26	$61.66	$83.18	$91.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $275.42 / $407.38	Professional		$181.97	$275.42	$407.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $70.79 / $107.15	Professional	26	$42.66	$70.79	$107.15
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $223.87 / $331.13	Professional	TC	$162.18	$223.87	$331.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $70.79 / $72.44	Facility	26	$58.88	$70.79	$72.44
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $85.11	Professional		$85.11	$85.11	$85.11
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $63.10 / $74.13	Professional	26	$43.65	$63.10	$74.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $190.55 / $229.09	Professional	TC	$141.25	$190.55	$229.09
Providence Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $302.00 / $426.58	Professional		$234.42	$302.00	$426.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $74.13 / $100.00	Professional	26	$47.86	$74.13	$100.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $229.09 / $323.59	Professional	TC	$151.36	$229.09	$323.59
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $316.23 / $407.38	Professional		$269.15	$316.23	$407.38
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $75.86 / $97.72	Professional	26	$64.57	$75.86	$97.72
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $239.88 / $309.03	Professional	TC	$208.93	$239.88	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $165.96 / $398.11	Professional		$144.54	$165.96	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $41.69 / $97.72	Professional	26	$36.31	$41.69	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $125.89 / $302.00	Professional	TC	$109.65	$125.89	$302.00