Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $95.50 / $120.23	Facility	26	$64.57	$95.50	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $223.87 / $630.96	Professional		$112.20	$223.87	$630.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $93.33 / $245.47	Professional	26	$42.66	$93.33	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $85.11 / $218.78	Professional	TC	$57.54	$85.11	$218.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $229.09 / $331.13	Professional		$128.82	$229.09	$331.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $89.13 / $138.04	Professional	26	$50.12	$89.13	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $138.04 / $204.17	Professional	TC	$75.86	$138.04	$204.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $245.47 / $309.03	Professional		$199.53	$245.47	$309.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $97.72 / $114.82	Professional	26	$75.86	$97.72	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $151.36 / $190.55	Professional	TC	$123.03	$151.36	$190.55
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $91.20 / $131.83	Facility	26	$64.57	$91.20	$131.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $223.87 / $363.08	Professional		$131.83	$223.87	$363.08
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $93.33 / $147.91	Professional	26	$53.70	$93.33	$147.91
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $144.54 / $204.17	Professional	TC	$83.18	$144.54	$204.17
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $93.33 / $95.50	Facility	26	$75.86	$93.33	$95.50
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $131.83 / $131.83	Professional		$131.83	$131.83	$131.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $81.28 / $104.71	Professional	26	$60.26	$81.28	$104.71
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $123.03 / $158.49	Professional	TC	$87.10	$123.03	$158.49
Providence Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $245.47 / $338.84	Professional		$186.21	$245.47	$338.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $95.50 / $131.83	Professional	26	$64.57	$95.50	$131.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $147.91 / $204.17	Professional	TC	$102.33	$147.91	$204.17
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 $213.80 / $251.19 / $323.59	Professional		$213.80	$251.19	$323.59
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $100.00 / $131.83	Professional	26	$85.11	$100.00	$131.83
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $151.36 / $194.98	Professional	TC	$128.82	$151.36	$194.98
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $141.25 / $316.23	Professional		$125.89	$141.25	$316.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $53.70 / $125.89	Professional	26	$47.86	$53.70	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $83.18 / $190.55	Professional	TC	$74.13	$83.18	$190.55