Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $57.54 / $67.61	Facility	26	$36.31	$57.54	$67.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $123.03 / $309.03	Professional		$83.18	$123.03	$309.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $27.54 / $60.26	Professional	26	$19.95	$27.54	$60.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $100.00 / $239.88	Professional	TC	$69.18	$100.00	$239.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $234.42 / $371.54	Professional		$112.20	$234.42	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $50.12 / $77.62	Professional	26	$28.84	$50.12	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $181.97 / $302.00	Professional	TC	$85.11	$181.97	$302.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $288.40 / $354.81	Professional		$263.03	$288.40	$354.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $57.54 / $69.18	Professional	26	$51.29	$57.54	$69.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $234.42 / $288.40	Professional	TC	$208.93	$234.42	$288.40
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $245.47 / $389.05	Professional		$144.54	$245.47	$389.05
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $54.95 / $79.43	Professional	26	$34.67	$54.95	$79.43
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $213.80 / $309.03	Professional	TC	$120.23	$213.80	$309.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $52.48 / $52.48	Facility	26	$43.65	$52.48	$52.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $46.77 / $56.23	Professional	26	$31.62	$46.77	$56.23
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $131.83 / $204.17	Professional	TC	$93.33	$131.83	$204.17
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $6.46 / $30.20 / $43.65	Facility	26	$6.46	$30.20	$43.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $257.04 / $380.19	Professional		$177.83	$257.04	$380.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $54.95 / $77.62	Professional	26	$37.15	$54.95	$77.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $181.97 / $295.12	Professional	TC	$114.82	$181.97	$295.12
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,548.82 / $1,548.82 / $1,548.82	Facility	26	$1,548.82	$1,548.82	$1,548.82
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $251.19 / $346.74	Professional		$190.55	$251.19	$346.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $54.95 / $70.79	Professional	26	$47.86	$54.95	$70.79
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $199.53 / $275.42	Professional	TC	$147.91	$199.53	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $138.04 / $346.74	Professional		$102.33	$138.04	$346.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $33.11 / $72.44	Professional	26	$26.30	$33.11	$72.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $107.15 / $275.42	Professional	TC	$72.44	$107.15	$275.42