Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $323.59 / $346.74	Facility	26	$32.36	$323.59	$346.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $158.49 / $549.54	Professional		$97.72	$158.49	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $38.02 / $125.89	Professional	26	$22.91	$38.02	$125.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $91.20 / $169.82	Professional	TC	$67.61	$91.20	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $199.53 / $281.84	Professional		$123.03	$199.53	$281.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $46.77 / $70.79	Professional	26	$30.20	$46.77	$70.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $151.36 / $218.78	Professional	TC	$89.13	$151.36	$218.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $213.80 / $263.03	Professional		$173.78	$213.80	$263.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $52.48 / $61.66	Professional	26	$40.74	$52.48	$61.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $162.18 / $204.17	Professional	TC	$134.90	$162.18	$204.17
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $323.59 / $380.19	Facility	26	$39.81	$323.59	$380.19
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $190.55 / $288.40	Professional		$131.83	$190.55	$288.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $50.12 / $77.62	Professional	26	$25.70	$50.12	$77.62
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $154.88 / $218.78	Professional	TC	$91.20	$154.88	$218.78
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $47.86 / $51.29	Facility	26	$39.81	$47.86	$51.29
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $125.89 / $125.89	Professional		$112.20	$125.89	$125.89
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $42.66 / $53.70	Professional	26	$29.51	$42.66	$53.70
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $138.04 / $186.21	Professional	TC	$100.00	$138.04	$186.21
Providence Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $213.80 / $275.42	Professional		$158.49	$213.80	$275.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $50.12 / $67.61	Professional	26	$34.67	$50.12	$67.61
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $151.36 / $213.80	Professional	TC	$107.15	$151.36	$213.80
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $213.80 / $269.15	Professional		$181.97	$213.80	$269.15
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $52.48 / $66.07	Professional	26	$44.67	$52.48	$66.07
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $162.18 / $204.17	Professional	TC	$134.90	$162.18	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $186.21 / $288.40	Professional		$100.00	$186.21	$288.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $46.77 / $70.79	Professional	26	$26.30	$46.77	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $138.04 / $213.80	Professional	TC	$74.13	$138.04	$213.80