Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.79 / $89.03 / $199.49	Facility	26	$61.79	$89.03	$199.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.52 / $76.15 / $308.54	Professional		$52.52	$76.15	$308.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.49 / $40.58 / $97.95	Professional	26	$36.49	$40.58	$97.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.03 / $58.47 / $219.51	Professional	TC	$16.03	$58.47	$219.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $263.33 / $380.23	Professional		$144.54	$263.33	$380.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.05 / $84.48 / $115.06	Professional	26	$59.05	$84.48	$115.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.03 / $183.21 / $273.95	Professional	TC	$78.03	$183.21	$273.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $275.86 / $322.33 / $373.65	Professional		$275.86	$322.33	$373.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $77.11 / $92.46 / $104.45	Professional	26	$77.11	$92.46	$104.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $198.75 / $229.27 / $269.20	Professional	TC	$198.75	$229.27	$269.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $76.50 / $219.35 / $418.86	Professional		$76.50	$219.35	$418.86
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.05 / $88.54 / $127.33	Professional	26	$64.05	$88.54	$127.33
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.88 / $198.80 / $308.75	Professional	TC	$77.88	$198.80	$308.75
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.30 / $75.70 / $79.30	Facility	26	$53.30	$75.70	$79.30
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $86.08 / $86.08 / $162.34	Professional		$86.08	$86.08	$162.34
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $49.04 / $71.92 / $81.84	Professional	26	$49.04	$71.92	$81.84
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $15.08 / $74.78 / $173.23	Professional	TC	$15.08	$74.78	$173.23
Providence Facility/Professional Professional Modifier Low / Median / High Price $102.00 / $281.95 / $380.23	Professional		$102.00	$281.95	$380.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $52.55 / $75.70 / $108.40	Professional	26	$52.55	$75.70	$108.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $60.56 / $163.29 / $273.95	Professional	TC	$60.56	$163.29	$273.95
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $422.45 / $422.45 / $422.45	Facility	26	$422.45	$422.45	$422.45
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $238.26 / $319.14 / $390.37	Professional		$238.26	$319.14	$390.37
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $74.34 / $91.13 / $111.81	Professional	26	$74.34	$91.13	$111.81
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $155.51 / $218.65 / $278.57	Professional	TC	$155.51	$218.65	$278.57
United Facility/Professional Professional Modifier Low / Median / High Price $66.48 / $153.84 / $438.34	Professional		$66.48	$153.84	$438.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.98 / $59.00 / $130.58	Professional	26	$50.98	$59.00	$130.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.68 / $102.86 / $312.79	Professional	TC	$11.68	$102.86	$312.79