Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.42 / $32.36 / $38.02	Facility	26	$20.42	$32.36	$38.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $93.33 / $251.19	Professional		$58.88	$93.33	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $21.88 / $56.23	Professional	26	$14.13	$21.88	$56.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $67.61 / $112.20	Professional	TC	$42.66	$67.61	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $131.83 / $199.53	Professional		$64.57	$131.83	$199.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $28.18 / $44.67	Professional	26	$17.38	$28.18	$44.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $100.00 / $158.49	Professional	TC	$50.12	$100.00	$158.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $154.88 / $190.55	Professional		$138.04	$154.88	$190.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $32.36 / $38.90	Professional	26	$28.84	$32.36	$38.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $123.03 / $154.88	Professional	TC	$109.65	$123.03	$154.88
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $20.42 / $30.20 / $38.02	Facility	26	$20.42	$30.20	$38.02
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $125.89 / $208.93	Professional		$74.13	$125.89	$208.93
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $26.30 / $44.67	Professional	26	$17.38	$26.30	$44.67
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $107.15 / $154.88	Professional	TC	$54.95	$107.15	$154.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $24.55 / $29.51 / $30.90	Facility	26	$24.55	$29.51	$30.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $24.55 / $33.88	Professional	26	$18.62	$24.55	$33.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $91.20 / $112.20	Professional	TC	$61.66	$91.20	$112.20
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.72 / $17.38 / $24.55	Facility	26	$3.72	$17.38	$24.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $147.91 / $204.17	Professional		$107.15	$147.91	$204.17
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $32.36 / $44.67	Professional	26	$20.42	$32.36	$44.67
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $109.65 / $162.18	Professional	TC	$64.57	$109.65	$162.18
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $144.54 / $186.21	Professional		$107.15	$144.54	$186.21
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $32.36 / $40.74	Professional	26	$26.92	$32.36	$40.74
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $109.65 / $144.54	Professional	TC	$79.43	$109.65	$144.54
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $79.43 / $181.97	Professional		$63.10	$79.43	$181.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $19.95 / $42.66	Professional	26	$16.22	$19.95	$42.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $61.66 / $144.54	Professional	TC	$46.77	$61.66	$144.54