Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.75 / $65.89 / $133.50	Facility	26	$57.75	$65.89	$133.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.06 / $128.04 / $302.60	Professional		$87.06	$128.04	$302.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.71 / $30.36 / $65.89	Professional	26	$21.71	$30.36	$65.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.90 / $101.94 / $240.55	Professional	TC	$69.90	$101.94	$240.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.37 / $30.37 / $30.37	Facility	26	$30.37	$30.37	$30.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.00 / $224.69 / $366.63	Professional		$112.00	$224.69	$366.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.84 / $51.78 / $75.81	Professional	26	$29.84	$51.78	$75.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.56 / $177.98 / $295.32	Professional	TC	$85.56	$177.98	$295.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $255.91 / $304.68 / $353.92	Professional		$255.91	$304.68	$353.92
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.10 / $61.27 / $68.98	Professional	26	$51.10	$61.27	$68.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $203.24 / $242.67 / $284.94	Professional	TC	$203.24	$242.67	$284.94
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $163.71 / $213.35 / $402.57	Professional		$163.71	$213.35	$402.57
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.70 / $52.28 / $81.33	Professional	26	$42.70	$52.28	$81.33
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $145.19 / $204.35 / $321.24	Professional	TC	$145.19	$204.35	$321.24
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.22 / $52.26 / $52.93	Facility	26	$38.22	$52.26	$52.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.15 / $46.80 / $56.16	Professional	26	$32.15	$46.80	$56.16
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $93.02 / $132.60 / $203.24	Professional	TC	$93.02	$132.60	$203.24
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $30.37 / $30.37 / $30.37	Facility	26	$30.37	$30.37	$30.37
Providence Facility/Professional Professional Modifier Low / Median / High Price $174.46 / $266.17 / $378.10	Professional		$174.46	$266.17	$378.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.24 / $53.00 / $77.69	Professional	26	$36.24	$53.00	$77.69
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $112.25 / $202.17 / $297.41	Professional	TC	$112.25	$202.17	$297.41
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,538.06 / $1,538.06 / $1,538.06	Facility	26	$1,538.06	$1,538.06	$1,538.06
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $197.42 / $267.85 / $363.02	Professional		$197.42	$267.85	$363.02
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $47.88 / $55.19 / $74.95	Professional	26	$47.88	$55.19	$74.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $148.83 / $214.01 / $290.05	Professional	TC	$148.83	$214.01	$290.05
United Facility/Professional Professional Modifier Low / Median / High Price $101.33 / $134.19 / $410.25	Professional		$101.33	$134.19	$410.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.93 / $34.00 / $80.62	Professional	26	$27.93	$34.00	$80.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.22 / $118.86 / $275.49	Professional	TC	$73.22	$118.86	$275.49