Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.80 / $83.01 / $119.70	Facility	26	$49.80	$83.01	$119.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.34 / $166.76 / $318.54	Professional		$145.34	$166.76	$318.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.14 / $52.49 / $118.33	Professional	26	$33.14	$52.49	$118.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.12 / $112.69 / $250.03	Professional	TC	$94.12	$112.69	$250.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.13 / $191.83 / $307.64	Professional		$77.13	$191.83	$307.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.51 / $47.36 / $73.33	Professional	26	$28.51	$47.36	$73.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.48 / $144.47 / $239.24	Professional	TC	$46.48	$144.47	$239.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $166.55 / $396.63 / $437.20	Professional		$166.55	$396.63	$437.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.84 / $89.90 / $99.09	Professional	26	$39.84	$89.90	$99.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $126.71 / $306.70 / $338.09	Professional	TC	$126.71	$306.70	$338.09
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $239.19 / $295.49 / $553.83	Professional		$239.19	$295.49	$553.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.18 / $94.26 / $131.56	Professional	26	$66.18	$94.26	$131.56
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $133.00 / $225.30 / $422.27	Professional	TC	$133.00	$225.30	$422.27
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $82.51 / $104.15	Facility	26	$62.50	$82.51	$104.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.91 / $82.56 / $106.53	Professional	26	$57.91	$82.56	$106.53
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $135.16 / $201.78 / $277.14	Professional	TC	$135.16	$201.78	$277.14
Providence Facility/Professional Professional Modifier Low / Median / High Price $191.83 / $348.60 / $501.60	Professional		$191.83	$348.60	$501.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.59 / $47.36 / $79.66	Professional	26	$28.59	$47.36	$79.66
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $58.85 / $144.47 / $239.24	Professional	TC	$58.85	$144.47	$239.24
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $435.36 / $435.36 / $435.36	Facility	26	$435.36	$435.36	$435.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $321.99 / $380.72 / $568.17	Professional		$321.99	$380.72	$568.17
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $74.81 / $96.30 / $132.43	Professional	26	$74.81	$96.30	$132.43
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $247.18 / $284.42 / $435.74	Professional	TC	$247.18	$284.42	$435.74
United Facility/Professional Professional Modifier Low / Median / High Price $94.43 / $110.44 / $337.88	Professional		$94.43	$110.44	$337.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.95 / $27.50 / $101.70	Professional	26	$26.95	$27.50	$101.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.48 / $82.94 / $456.97	Professional	TC	$67.48	$82.94	$456.97