Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $74.13 / $81.28	Facility	26	$43.65	$74.13	$81.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $186.21 / $524.81	Professional		$117.49	$186.21	$524.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $42.66 / $169.82	Professional	26	$28.18	$42.66	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $109.65 / $223.87	Professional	TC	$72.44	$109.65	$223.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $323.59 / $562.34	Professional		$128.82	$323.59	$562.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $61.66 / $91.20	Professional	26	$35.48	$61.66	$91.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $269.15 / $478.63	Professional	TC	$85.11	$269.15	$478.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $257.04 / $416.87	Professional		$208.93	$257.04	$416.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $67.61 / $79.43	Professional	26	$52.48	$67.61	$79.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $190.55 / $354.81	Professional	TC	$154.88	$190.55	$354.81
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $54.95 / $75.86	Facility	26	$54.95	$54.95	$75.86
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $239.88 / $524.81	Professional		$131.83	$239.88	$524.81
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $64.57 / $95.50	Professional	26	$33.88	$64.57	$95.50
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $181.97 / $436.52	Professional	TC	$100.00	$181.97	$436.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $63.10 / $64.57	Facility	26	$52.48	$63.10	$64.57
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $87.10 / $87.10	Professional		$56.23	$87.10	$87.10
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $57.54 / $67.61	Professional	26	$39.81	$57.54	$67.61
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $120.23 / $275.42	Professional	TC	$79.43	$120.23	$275.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $380.19 / $549.54	Professional		$173.78	$380.19	$549.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $66.07 / $91.20	Professional	26	$44.67	$66.07	$91.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $245.47 / $467.74	Professional	TC	$100.00	$245.47	$467.74
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 $223.87 / $407.38 / $549.54	Professional		$223.87	$407.38	$549.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $67.61 / $87.10	Professional	26	$57.54	$67.61	$87.10
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $338.84 / $457.09	Professional	TC	$158.49	$338.84	$457.09
United Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $181.97 / $478.63	Professional		$95.50	$181.97	$478.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $37.15 / $85.11	Professional	26	$33.88	$37.15	$85.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $147.91 / $371.54	Professional	TC	$61.66	$147.91	$371.54