Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.56 / $55.56 / $60.82	Facility	26	$55.56	$55.56	$60.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.26 / $138.72 / $357.34	Professional		$95.26	$138.72	$357.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.20 / $32.61 / $62.59	Professional	26	$26.20	$32.61	$62.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.98 / $101.94 / $288.10	Professional	TC	$65.98	$101.94	$288.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $197.88 / $355.73 / $530.45	Professional		$197.88	$355.73	$530.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.11 / $54.83 / $81.50	Professional	26	$35.11	$54.83	$81.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $161.83 / $290.19 / $453.75	Professional	TC	$161.83	$290.19	$453.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $308.88 / $359.96 / $439.81	Professional		$308.88	$359.96	$439.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $66.84 / $78.90 / $91.28	Professional	26	$66.84	$78.90	$91.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $241.18 / $282.20 / $348.52	Professional	TC	$241.18	$282.20	$348.52
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $257.77 / $328.44 / $484.92	Professional		$257.77	$328.44	$484.92
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.50 / $61.46 / $112.47	Professional	26	$52.50	$61.46	$112.47
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $201.22 / $274.39 / $400.00	Professional	TC	$201.22	$274.39	$400.00
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.85 / $48.91 / $58.30	Facility	26	$35.85	$48.91	$58.30
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.74 / $44.50 / $59.63	Professional	26	$33.74	$44.50	$59.63
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $162.01 / $233.74 / $328.16	Professional	TC	$162.01	$233.74	$328.16
Providence Facility/Professional Professional Modifier Low / Median / High Price $277.20 / $374.26 / $469.18	Professional		$277.20	$374.26	$469.18
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $35.63 / $55.76 / $76.88	Professional	26	$35.63	$55.76	$76.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $184.82 / $311.70 / $399.25	Professional	TC	$184.82	$311.70	$399.25
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 $302.02 / $383.50 / $451.96	Professional		$302.02	$383.50	$451.96
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $46.81 / $57.85 / $70.11	Professional	26	$46.81	$57.85	$70.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $255.17 / $325.64 / $381.84	Professional	TC	$255.17	$325.64	$381.84
United Facility/Professional Professional Modifier Low / Median / High Price $180.18 / $319.27 / $494.17	Professional		$180.18	$319.27	$494.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.34 / $51.76 / $77.53	Professional	26	$29.34	$51.76	$77.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $175.00 / $277.62 / $428.73	Professional	TC	$175.00	$277.62	$428.73