Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.16 / $32.19 / $74.78	Facility	26	$21.16	$32.19	$74.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.75 / $83.57 / $287.00	Professional		$56.75	$83.57	$287.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $21.16 / $82.19	Professional	26	$14.36	$21.16	$82.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.39 / $58.80 / $126.48	Professional	TC	$42.39	$58.80	$126.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.47 / $124.76 / $195.44	Professional		$67.47	$124.76	$195.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.79 / $29.76 / $44.31	Professional	26	$17.79	$29.76	$44.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.50 / $98.43 / $156.12	Professional	TC	$50.50	$98.43	$156.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.99 / $165.50 / $192.07	Professional		$138.99	$165.50	$192.07
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.68 / $34.31 / $38.63	Professional	26	$28.68	$34.31	$38.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $109.43 / $130.66 / $153.41	Professional	TC	$109.43	$130.66	$153.41
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $105.60 / $122.85 / $214.50	Professional		$105.60	$122.85	$214.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.02 / $31.92 / $45.75	Professional	26	$24.02	$31.92	$45.75
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $88.61 / $117.07 / $168.75	Professional	TC	$88.61	$117.07	$168.75
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $22.29 / $29.56 / $30.82	Facility	26	$22.29	$29.56	$30.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.39 / $24.75 / $33.58	Professional	26	$18.39	$24.75	$33.58
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $61.92 / $91.30 / $111.22	Professional	TC	$61.92	$91.30	$111.22
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Providence Facility/Professional Professional Modifier Low / Median / High Price $103.25 / $151.19 / $200.45	Professional		$103.25	$151.19	$200.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $20.39 / $31.26 / $44.32	Professional	26	$20.39	$31.26	$44.32
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $68.23 / $109.49 / $156.12	Professional	TC	$68.23	$109.49	$156.12
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 $107.63 / $146.63 / $191.97	Professional		$107.63	$146.63	$191.97
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $26.93 / $32.54 / $42.64	Professional	26	$26.93	$32.54	$42.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $79.34 / $113.71 / $151.03	Professional	TC	$79.34	$113.71	$151.03
United Facility/Professional Professional Modifier Low / Median / High Price $62.88 / $81.66 / $196.38	Professional		$62.88	$81.66	$196.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.48 / $18.13 / $47.10	Professional	26	$16.48	$18.13	$47.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.35 / $61.15 / $148.61	Professional	TC	$46.35	$61.15	$148.61