Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.58 / $69.62 / $150.68	Facility	26	$54.58	$69.62	$150.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.48 / $187.31 / $422.00	Professional		$118.48	$187.31	$422.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.53 / $39.11 / $168.21	Professional	26	$30.53	$39.11	$168.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.95 / $109.52 / $259.74	Professional	TC	$87.95	$109.52	$259.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $129.59 / $320.68 / $570.90	Professional		$129.59	$320.68	$570.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.31 / $67.18 / $94.40	Professional	26	$38.31	$67.18	$94.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $94.00 / $255.93 / $482.97	Professional	TC	$94.00	$255.93	$482.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $377.22 / $439.61 / $538.98	Professional		$377.22	$439.61	$538.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.78 / $71.92 / $83.00	Professional	26	$60.78	$71.92	$83.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $315.51 / $369.19 / $455.96	Professional	TC	$315.51	$369.19	$455.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $159.50 / $323.88 / $613.02	Professional		$159.50	$323.88	$613.02
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.23 / $64.02 / $101.84	Professional	26	$51.23	$64.02	$101.84
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $239.21 / $322.13 / $523.05	Professional	TC	$239.21	$322.13	$523.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $46.55 / $63.61 / $64.98	Facility	26	$46.55	$63.61	$64.98
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $86.94 / $105.65 / $105.65	Professional		$86.94	$105.65	$105.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.65 / $57.00 / $69.80	Professional	26	$44.65	$57.00	$69.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $82.50 / $143.08 / $299.24	Professional	TC	$82.50	$143.08	$299.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $172.92 / $387.90 / $575.01	Professional		$172.92	$387.90	$575.01
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.04 / $69.70 / $94.40	Professional	26	$43.04	$69.70	$94.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $98.54 / $275.99 / $479.21	Professional	TC	$98.54	$275.99	$479.21
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $252.92 / $446.46 / $571.34	Professional		$252.92	$446.46	$571.34
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $58.19 / $76.26 / $90.01	Professional	26	$58.19	$76.26	$90.01
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $188.90 / $376.12 / $481.33	Professional	TC	$188.90	$376.12	$481.33
United Facility/Professional Professional Modifier Low / Median / High Price $94.86 / $191.16 / $526.58	Professional		$94.86	$191.16	$526.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.14 / $38.22 / $98.41	Professional	26	$34.14	$38.22	$98.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.72 / $131.87 / $442.87	Professional	TC	$60.72	$131.87	$442.87