Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.72 / $52.72 / $57.43	Facility	26	$52.72	$52.72	$57.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $164.55 / $241.10 / $513.36	Professional		$164.55	$241.10	$513.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.30 / $29.88 / $71.14	Professional	26	$23.30	$29.88	$71.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.78 / $211.71 / $395.07	Professional	TC	$138.78	$211.71	$395.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $210.27 / $352.08 / $536.10	Professional		$210.27	$352.08	$536.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.33 / $49.58 / $72.02	Professional	26	$28.33	$49.58	$72.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $184.82 / $304.77 / $463.88	Professional	TC	$184.82	$304.77	$463.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $304.38 / $354.72 / $435.29	Professional		$304.38	$354.72	$435.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $43.44 / $51.52 / $59.32	Professional	26	$43.44	$51.52	$59.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $260.17 / $304.42 / $375.96	Professional	TC	$260.17	$304.42	$375.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $254.58 / $314.75 / $479.85	Professional		$254.58	$314.75	$479.85
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.36 / $47.52 / $74.26	Professional	26	$37.36	$47.52	$74.26
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $217.22 / $284.61 / $431.81	Professional	TC	$217.22	$284.61	$431.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $34.79 / $45.56 / $47.82	Facility	26	$34.79	$45.56	$47.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.14 / $40.47 / $50.06	Professional	26	$28.14	$40.47	$50.06
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $169.24 / $250.25 / $322.93	Professional	TC	$169.24	$250.25	$322.93
Providence Facility/Professional Professional Modifier Low / Median / High Price $293.88 / $363.16 / $461.05	Professional		$293.88	$363.16	$461.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $32.61 / $51.57 / $66.87	Professional	26	$32.61	$51.57	$66.87
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $191.88 / $313.47 / $423.70	Professional	TC	$191.88	$313.47	$423.70
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $459.43 / $459.43 / $459.43	Facility	26	$459.43	$459.43	$459.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $298.86 / $374.64 / $447.22	Professional		$298.86	$374.64	$447.22
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.67 / $54.64 / $67.27	Professional	26	$43.67	$54.64	$67.27
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $253.91 / $320.01 / $379.95	Professional	TC	$253.91	$320.01	$379.95
United Facility/Professional Professional Modifier Low / Median / High Price $180.55 / $323.70 / $478.52	Professional		$180.55	$323.70	$478.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.75 / $48.99 / $74.84	Professional	26	$27.75	$48.99	$74.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $172.91 / $277.38 / $405.17	Professional	TC	$172.91	$277.38	$405.17