Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $66.07 / $93.33	Facility	26	$41.69	$66.07	$93.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $158.49 / $630.96	Professional		$85.11	$158.49	$630.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $56.23 / $169.82	Professional	26	$27.54	$56.23	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $95.50 / $199.53	Professional	TC	$56.23	$95.50	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $190.55 / $288.40	Professional		$87.10	$190.55	$288.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $56.23 / $85.11	Professional	26	$32.36	$56.23	$85.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $131.83 / $204.17	Professional	TC	$58.88	$131.83	$204.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $208.93 / $257.04	Professional		$169.82	$208.93	$257.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $61.66 / $74.13	Professional	26	$47.86	$61.66	$74.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $147.91 / $186.21	Professional	TC	$120.23	$147.91	$186.21
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $61.66 / $131.83	Facility	26	$41.69	$61.66	$131.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $190.55 / $302.00	Professional		$112.20	$190.55	$302.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $60.26 / $95.50	Professional	26	$33.88	$60.26	$95.50
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $141.25 / $199.53	Professional	TC	$81.28	$141.25	$199.53
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $58.88 / $61.66	Facility	26	$48.98	$58.88	$61.66
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $51.29 / $66.07	Professional	26	$36.31	$51.29	$66.07
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $87.10 / $162.18	Professional	TC	$47.86	$87.10	$162.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $208.93 / $288.40	Professional		$134.90	$208.93	$288.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $61.66 / $85.11	Professional	26	$40.74	$61.66	$85.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $147.91 / $204.17	Professional	TC	$69.18	$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 $141.25 / $213.80 / $275.42	Professional		$141.25	$213.80	$275.42
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $64.57 / $83.18	Professional	26	$54.95	$64.57	$83.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $151.36 / $190.55	Professional	TC	$97.72	$151.36	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $120.23 / $263.03	Professional		$74.13	$120.23	$263.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $34.67 / $81.28	Professional	26	$30.90	$34.67	$81.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $85.11 / $181.97	Professional	TC	$42.66	$85.11	$181.97