Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.79 / $44.73 / $51.05	Facility	26	$36.79	$44.73	$51.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.56 / $138.00 / $410.02	Professional		$109.56	$138.00	$410.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.49 / $24.44 / $71.14	Professional	26	$14.49	$24.44	$71.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.53 / $112.50 / $266.81	Professional	TC	$95.53	$112.50	$266.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $159.84 / $275.39 / $403.13	Professional		$159.84	$275.39	$403.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.52 / $45.25 / $71.52	Professional	26	$23.52	$45.25	$71.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $135.79 / $227.90 / $341.97	Professional	TC	$135.79	$227.90	$341.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $233.68 / $272.33 / $333.15	Professional		$233.68	$272.33	$333.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.34 / $50.28 / $57.82	Professional	26	$42.34	$50.28	$57.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $190.54 / $222.94 / $275.33	Professional	TC	$190.54	$222.94	$275.33
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $197.99 / $246.33 / $376.14	Professional		$197.99	$246.33	$376.14
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.00 / $44.44 / $72.16	Professional	26	$33.00	$44.44	$72.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $159.04 / $210.54 / $316.16	Professional	TC	$159.04	$210.54	$316.16
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $28.60 / $43.25 / $46.90	Facility	26	$28.60	$43.25	$46.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $22.11 / $30.36 / $51.75	Professional	26	$22.11	$30.36	$51.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $134.06 / $202.86 / $266.66	Professional	TC	$134.06	$202.86	$266.66
Providence Facility/Professional Professional Modifier Low / Median / High Price $228.88 / $290.60 / $362.78	Professional		$228.88	$290.60	$362.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.41 / $46.76 / $66.81	Professional	26	$26.41	$46.76	$66.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $139.56 / $236.03 / $330.88	Professional	TC	$139.56	$236.03	$330.88
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 $234.28 / $297.05 / $350.58	Professional		$234.28	$297.05	$350.58
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $34.33 / $53.85 / $65.59	Professional	26	$34.33	$53.85	$65.59
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $191.22 / $247.34 / $286.14	Professional	TC	$191.22	$247.34	$286.14
United Facility/Professional Professional Modifier Low / Median / High Price $165.60 / $263.16 / $393.63	Professional		$165.60	$263.16	$393.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.26 / $45.50 / $71.68	Professional	26	$25.26	$45.50	$71.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.69 / $204.52 / $312.87	Professional	TC	$131.69	$204.52	$312.87