Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $46.77 / $51.29	Facility	26	$32.36	$46.77	$51.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $109.65 / $251.19	Professional		$74.13	$109.65	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $27.54 / $63.10	Professional	26	$16.98	$27.54	$63.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $75.86 / $173.78	Professional	TC	$52.48	$75.86	$173.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $177.83 / $281.84	Professional		$87.10	$177.83	$281.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $37.15 / $57.54	Professional	26	$21.88	$37.15	$57.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $141.25 / $223.87	Professional	TC	$64.57	$141.25	$223.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $213.80 / $269.15	Professional		$190.55	$213.80	$269.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $42.66 / $51.29	Professional	26	$37.15	$42.66	$51.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $169.82 / $218.78	Professional	TC	$151.36	$169.82	$218.78
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $39.81 / $51.29	Facility	26	$27.54	$39.81	$51.29
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $194.98 / $295.12	Professional		$100.00	$194.98	$295.12
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $40.74 / $60.26	Professional	26	$20.89	$40.74	$60.26
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $158.49 / $234.42	Professional	TC	$75.86	$158.49	$234.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $38.90 / $39.81	Facility	26	$32.36	$38.90	$39.81
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $89.13 / $89.13	Professional		$67.61	$89.13	$89.13
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $32.36 / $41.69	Professional	26	$23.99	$32.36	$41.69
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $128.82 / $158.49	Professional	TC	$81.28	$128.82	$158.49
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $4.90 / $22.91 / $32.36	Facility	26	$4.90	$22.91	$32.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $204.17 / $288.40	Professional		$144.54	$204.17	$288.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $41.69 / $58.88	Professional	26	$26.30	$41.69	$58.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $154.88 / $234.42	Professional	TC	$91.20	$154.88	$234.42
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 $138.04 / $199.53 / $263.03	Professional		$138.04	$199.53	$263.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $42.66 / $53.70	Professional	26	$35.48	$42.66	$53.70
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $154.88 / $208.93	Professional	TC	$109.65	$154.88	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $109.65 / $257.04	Professional		$81.28	$109.65	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $25.70 / $53.70	Professional	26	$20.42	$25.70	$53.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $81.28 / $208.93	Professional	TC	$60.26	$81.28	$208.93