Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $75.86 / $117.49	Facility	26	$45.71	$75.86	$117.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $165.96 / $630.96	Professional		$91.20	$165.96	$630.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $52.48 / $162.18	Professional	26	$28.18	$52.48	$162.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $95.50 / $234.42	Professional	TC	$60.26	$95.50	$234.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $208.93 / $309.03	Professional		$107.15	$208.93	$309.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $61.66 / $91.20	Professional	26	$34.67	$61.66	$91.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $144.54 / $213.80	Professional	TC	$72.44	$144.54	$213.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $223.87 / $275.42	Professional		$181.97	$223.87	$275.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $67.61 / $81.28	Professional	26	$52.48	$67.61	$81.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $158.49 / $194.98	Professional	TC	$128.82	$158.49	$194.98
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $66.07 / $117.49	Facility	26	$45.71	$66.07	$117.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $204.17 / $316.23	Professional		$123.03	$204.17	$316.23
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $66.07 / $102.33	Professional	26	$34.67	$66.07	$102.33
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $147.91 / $204.17	Professional	TC	$83.18	$147.91	$204.17
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $64.57 / $66.07	Facility	26	$52.48	$64.57	$66.07
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Professional		$109.65	$109.65	$109.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $56.23 / $67.61	Professional	26	$38.90	$56.23	$67.61
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $128.82 / $165.96	Professional	TC	$91.20	$128.82	$165.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $229.09 / $302.00	Professional		$169.82	$229.09	$302.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $66.07 / $91.20	Professional	26	$43.65	$66.07	$91.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $158.49 / $208.93	Professional	TC	$104.71	$158.49	$208.93
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 $190.55 / $229.09 / $288.40	Professional		$190.55	$229.09	$288.40
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $69.18 / $91.20	Professional	26	$58.88	$69.18	$91.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $162.18 / $199.53	Professional	TC	$131.83	$162.18	$199.53
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $125.89 / $288.40	Professional		$112.20	$125.89	$288.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $37.15 / $87.10	Professional	26	$33.11	$37.15	$87.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $87.10 / $199.53	Professional	TC	$75.86	$87.10	$199.53