Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $97.72 / $120.23	Facility	26	$64.57	$97.72	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $234.42 / $707.95	Professional		$125.89	$234.42	$707.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $91.20 / $245.47	Professional	26	$42.66	$91.20	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $109.65 / $275.42	Professional	TC	$72.44	$109.65	$275.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $263.03 / $389.05	Professional		$141.25	$263.03	$389.05
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 $91.20 / $173.78 / $257.04	Professional	TC	$91.20	$173.78	$257.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $288.40 / $354.81	Professional		$229.09	$288.40	$354.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $97.72 / $117.49	Professional	26	$75.86	$97.72	$117.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $190.55 / $239.88	Professional	TC	$154.88	$190.55	$239.88
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $87.10 / $131.83	Facility	26	$64.57	$87.10	$131.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $257.04 / $398.11	Professional		$158.49	$257.04	$398.11
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $95.50 / $147.91	Professional	26	$53.70	$95.50	$147.91
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $177.83 / $251.19	Professional	TC	$100.00	$177.83	$251.19
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $93.33 / $95.50	Facility	26	$77.62	$93.33	$95.50
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $83.18 / $100.00	Professional	26	$57.54	$83.18	$100.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $158.49 / $190.55	Professional	TC	$120.23	$158.49	$190.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $281.84 / $389.05	Professional		$218.78	$281.84	$389.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $97.72 / $131.83	Professional	26	$64.57	$97.72	$131.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $181.97 / $257.04	Professional	TC	$128.82	$181.97	$257.04
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 $245.47 / $288.40 / $371.54	Professional		$245.47	$288.40	$371.54
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 $162.18 / $190.55 / $239.88	Professional	TC	$162.18	$190.55	$239.88
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $158.49 / $371.54	Professional		$141.25	$158.49	$371.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $53.70 / $128.82	Professional	26	$47.86	$53.70	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $104.71 / $239.88	Professional	TC	$91.20	$104.71	$239.88