Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.17 / $39.17 / $57.43	Facility	26	$39.17	$39.17	$57.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.53 / $185.77 / $338.75	Professional		$131.53	$185.77	$338.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.76 / $24.87 / $81.83	Professional	26	$18.76	$24.87	$81.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $106.57 / $162.13 / $279.95	Professional	TC	$106.57	$162.13	$279.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.57 / $276.14 / $416.27	Professional		$158.57	$276.14	$416.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.61 / $48.06 / $72.23	Professional	26	$26.61	$48.06	$72.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $133.38 / $226.68 / $344.04	Professional	TC	$133.38	$226.68	$344.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $234.75 / $273.57 / $334.66	Professional		$234.75	$273.57	$334.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.76 / $50.77 / $58.39	Professional	26	$42.76	$50.77	$58.39
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $191.18 / $223.70 / $276.27	Professional	TC	$191.18	$223.70	$276.27
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $196.42 / $263.67 / $378.18	Professional		$196.42	$263.67	$378.18
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.83 / $45.09 / $73.20	Professional	26	$36.83	$45.09	$73.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $159.59 / $211.02 / $317.24	Professional	TC	$159.59	$211.02	$317.24
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $34.88 / $44.90 / $48.24	Facility	26	$34.88	$44.90	$48.24
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $27.93 / $36.00 / $53.38	Professional	26	$27.93	$36.00	$53.38
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $120.00 / $176.68 / $261.58	Professional	TC	$120.00	$176.68	$261.58
Providence Facility/Professional Professional Modifier Low / Median / High Price $227.63 / $284.45 / $366.00	Professional		$227.63	$284.45	$366.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $27.85 / $49.06 / $67.30	Professional	26	$27.85	$49.06	$67.30
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $139.10 / $233.82 / $328.32	Professional	TC	$139.10	$233.82	$328.32
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 $225.55 / $300.99 / $352.47	Professional		$225.55	$300.99	$352.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.70 / $54.64 / $67.27	Professional	26	$37.70	$54.64	$67.27
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $187.85 / $243.54 / $285.20	Professional	TC	$187.85	$243.54	$285.20
United Facility/Professional Professional Modifier Low / Median / High Price $166.29 / $254.81 / $395.77	Professional		$166.29	$254.81	$395.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.85 / $47.51 / $74.41	Professional	26	$27.85	$47.51	$74.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.36 / $202.30 / $311.83	Professional	TC	$114.36	$202.30	$311.83