Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.29 / $69.48 / $141.22	Facility	26	$60.29	$69.48	$141.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.50 / $127.64 / $294.22	Professional		$88.50	$127.64	$294.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.68 / $31.23 / $79.88	Professional	26	$22.68	$31.23	$79.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.45 / $98.15 / $231.82	Professional	TC	$66.45	$98.15	$231.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.15 / $32.15 / $32.15	Facility	26	$32.15	$32.15	$32.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.81 / $228.08 / $369.82	Professional		$109.81	$228.08	$369.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $54.53 / $80.68	Professional	26	$30.20	$54.53	$80.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $82.45 / $181.50 / $296.04	Professional	TC	$82.45	$181.50	$296.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $246.43 / $293.44 / $340.60	Professional		$246.43	$293.44	$340.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.79 / $63.41 / $71.40	Professional	26	$52.79	$63.41	$71.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $192.01 / $229.27 / $269.20	Professional	TC	$192.01	$229.27	$269.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $163.19 / $205.67 / $396.81	Professional		$163.19	$205.67	$396.81
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.30 / $54.33 / $84.39	Professional	26	$44.30	$54.33	$84.39
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $137.97 / $198.61 / $308.75	Professional	TC	$137.97	$198.61	$308.75
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $40.18 / $54.42 / $56.28	Facility	26	$40.18	$54.42	$56.28
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.77 / $49.02 / $56.58	Professional	26	$33.77	$49.02	$56.58
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $93.28 / $126.26 / $176.42	Professional	TC	$93.28	$126.26	$176.42
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $32.15 / $32.15 / $32.15	Facility	26	$32.15	$32.15	$32.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $173.46 / $270.27 / $376.12	Professional		$173.46	$270.27	$376.12
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.52 / $54.87 / $82.60	Professional	26	$37.52	$54.87	$82.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $109.78 / $192.74 / $296.04	Professional	TC	$109.78	$192.74	$296.04
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 $195.20 / $265.10 / $369.40	Professional		$195.20	$265.10	$369.40
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.68 / $58.72 / $78.64	Professional	26	$49.68	$58.72	$78.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $143.96 / $207.55 / $292.77	Professional	TC	$143.96	$207.55	$292.77
United Facility/Professional Professional Modifier Low / Median / High Price $102.41 / $133.18 / $358.66	Professional		$102.41	$133.18	$358.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.37 / $32.77 / $86.84	Professional	26	$29.37	$32.77	$86.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.94 / $100.86 / $271.39	Professional	TC	$72.94	$100.86	$271.39