Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.72 / $62.57 / $83.62	Facility	26	$59.72	$62.57	$83.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $183.96 / $220.88 / $802.17	Professional		$183.96	$220.88	$802.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.46 / $39.68 / $94.60	Professional	26	$21.46	$39.68	$94.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.80 / $179.39 / $419.38	Professional	TC	$151.80	$179.39	$419.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $248.14 / $435.78 / $616.36	Professional		$248.14	$435.78	$616.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.13 / $73.76 / $116.25	Professional	26	$37.13	$73.76	$116.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $210.00 / $361.27 / $545.55	Professional	TC	$210.00	$361.27	$545.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $376.40 / $438.65 / $536.65	Professional		$376.40	$438.65	$536.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.76 / $82.69 / $95.26	Professional	26	$69.76	$82.69	$95.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $305.45 / $357.38 / $441.36	Professional	TC	$305.45	$357.38	$441.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $322.52 / $384.14 / $596.76	Professional		$322.52	$384.14	$596.76
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $59.78 / $72.42 / $118.83	Professional	26	$59.78	$72.42	$118.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $255.12 / $337.07 / $507.15	Professional	TC	$255.12	$337.07	$507.15
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.23 / $70.97 / $76.38	Facility	26	$43.23	$70.97	$76.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.65 / $47.88 / $78.68	Professional	26	$32.65	$47.88	$78.68
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $210.09 / $318.25 / $413.67	Professional	TC	$210.09	$318.25	$413.67
Providence Facility/Professional Professional Modifier Low / Median / High Price $363.94 / $452.58 / $575.26	Professional		$363.94	$452.58	$575.26
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $42.90 / $77.05 / $107.91	Professional	26	$42.90	$77.05	$107.91
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $223.90 / $372.02 / $495.84	Professional	TC	$223.90	$372.02	$495.84
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $782.93 / $782.93 / $782.93	Facility	26	$782.93	$782.93	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $371.68 / $463.62 / $559.10	Professional		$371.68	$463.62	$559.10
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $55.72 / $87.42 / $106.82	Professional	26	$55.72	$87.42	$106.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $300.76 / $384.32 / $450.06	Professional	TC	$300.76	$384.32	$450.06
United Facility/Professional Professional Modifier Low / Median / High Price $220.92 / $405.53 / $608.53	Professional		$220.92	$405.53	$608.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.14 / $72.81 / $117.64	Professional	26	$41.14	$72.81	$117.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $210.19 / $336.06 / $484.76	Professional	TC	$210.19	$336.06	$484.76