Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.78 / $70.13 / $141.87	Facility	26	$60.78	$70.13	$141.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.26 / $118.42 / $283.13	Professional		$98.26	$118.42	$283.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.35 / $30.45 / $77.67	Professional	26	$26.35	$30.45	$77.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.89 / $82.04 / $170.43	Professional	TC	$71.89	$82.04	$170.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $118.48 / $217.37 / $307.80	Professional		$118.48	$217.37	$307.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.61 / $59.23 / $82.62	Professional	26	$32.61	$59.23	$82.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $86.40 / $165.83 / $225.19	Professional	TC	$86.40	$165.83	$225.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $202.60 / $236.10 / $287.43	Professional		$202.60	$236.10	$287.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.64 / $63.32 / $73.23	Professional	26	$53.64	$63.32	$73.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $148.24 / $173.43 / $214.19	Professional	TC	$148.24	$173.43	$214.19
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $169.19 / $207.13 / $336.33	Professional		$169.19	$207.13	$336.33
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.36 / $58.32 / $90.17	Professional	26	$45.36	$58.32	$90.17
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $123.82 / $158.96 / $246.13	Professional	TC	$123.82	$158.96	$246.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $36.96 / $56.02 / $56.28	Facility	26	$36.96	$56.02	$56.28
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $78.25 / $78.25	Professional		$78.25	$78.25	$78.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.77 / $46.20 / $56.28	Professional	26	$33.77	$46.20	$56.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $110.55 / $147.40 / $157.43	Professional	TC	$110.55	$147.40	$157.43
Providence Facility/Professional Professional Modifier Low / Median / High Price $179.61 / $231.62 / $303.61	Professional		$179.61	$231.62	$303.61
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.04 / $61.93 / $82.60	Professional	26	$38.04	$61.93	$82.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $101.51 / $173.26 / $225.19	Professional	TC	$101.51	$173.26	$225.19
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $379.18 / $379.18 / $379.18	Facility	26	$379.18	$379.18	$379.18
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $192.33 / $251.25 / $296.57	Professional		$192.33	$251.25	$296.57
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $51.45 / $68.77 / $80.56	Professional	26	$51.45	$68.77	$80.56
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $140.88 / $183.62 / $216.03	Professional	TC	$140.88	$183.62	$216.03
United Facility/Professional Professional Modifier Low / Median / High Price $109.24 / $119.79 / $314.20	Professional		$109.24	$119.79	$314.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.32 / $39.42 / $88.05	Professional	26	$30.32	$39.42	$88.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.70 / $91.48 / $227.37	Professional	TC	$78.70	$91.48	$227.37