Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.32 / $43.60 / $86.82	Facility	26	$37.32	$43.60	$86.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.64 / $83.58 / $199.03	Professional		$61.64	$83.58	$199.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.16 / $19.55 / $42.26	Professional	26	$14.16	$19.55	$42.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $45.97 / $56.75 / $137.30	Professional	TC	$45.97	$56.75	$137.30
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.60 / $19.60 / $19.60	Facility	26	$19.60	$19.60	$19.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.00 / $144.86 / $222.47	Professional		$74.00	$144.86	$222.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.38 / $33.74 / $50.15	Professional	26	$19.38	$33.74	$50.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.82 / $110.33 / $177.45	Professional	TC	$54.82	$110.33	$177.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $158.19 / $188.32 / $218.63	Professional		$158.19	$188.32	$218.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.77 / $39.27 / $44.24	Professional	26	$32.77	$39.27	$44.24
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $124.40 / $148.54 / $174.36	Professional	TC	$124.40	$148.54	$174.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $120.96 / $139.72 / $240.93	Professional		$120.96	$139.72	$240.93
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.23 / $36.18 / $54.12	Professional	26	$27.23	$36.18	$54.12
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.86 / $130.54 / $200.51	Professional	TC	$100.86	$130.54	$200.51
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $24.50 / $33.79 / $34.68	Facility	26	$24.50	$33.79	$34.68
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $43.34 / $78.25 / $86.94	Professional		$43.34	$78.25	$86.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $22.43 / $28.63 / $35.22	Professional	26	$22.43	$28.63	$35.22
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $79.09 / $102.85 / $125.29	Professional	TC	$79.09	$102.85	$125.29
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $19.60 / $19.60 / $19.60	Facility	26	$19.60	$19.60	$19.60
Providence Facility/Professional Professional Modifier Low / Median / High Price $113.22 / $170.38 / $227.95	Professional		$113.22	$170.38	$227.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.06 / $34.57 / $50.17	Professional	26	$23.06	$34.57	$50.17
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $79.34 / $123.22 / $177.45	Professional	TC	$79.34	$123.22	$177.45
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 $116.85 / $165.41 / $216.45	Professional		$116.85	$165.41	$216.45
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $30.52 / $36.79 / $48.32	Professional	26	$30.52	$36.79	$48.32
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $87.55 / $128.81 / $169.22	Professional	TC	$87.55	$128.81	$169.22
United Facility/Professional Professional Modifier Low / Median / High Price $68.27 / $85.13 / $228.08	Professional		$68.27	$85.13	$228.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.91 / $24.40 / $53.26	Professional	26	$17.91	$24.40	$53.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.30 / $71.80 / $174.40	Professional	TC	$50.30	$71.80	$174.40