Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $66.07 / $83.18	Facility	26	$39.81	$66.07	$83.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $102.33 / $288.40	Professional		$81.28	$102.33	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $38.02 / $97.72	Professional	26	$20.89	$38.02	$97.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $74.13 / $158.49	Professional	TC	$53.70	$74.13	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $181.97 / $281.84	Professional		$87.10	$181.97	$281.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $50.12 / $83.18	Professional	26	$24.55	$50.12	$83.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $131.83 / $204.17	Professional	TC	$61.66	$131.83	$204.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $208.93 / $263.03	Professional		$181.97	$208.93	$263.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $60.26 / $72.44	Professional	26	$52.48	$60.26	$72.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $151.36 / $186.21	Professional	TC	$128.82	$151.36	$186.21
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $57.54 / $83.18	Facility	26	$39.81	$57.54	$83.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $169.82 / $269.15	Professional		$102.33	$169.82	$269.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $56.23 / $85.11	Professional	26	$28.84	$56.23	$85.11
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $134.90 / $190.55	Professional	TC	$70.79	$134.90	$190.55
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $52.48 / $57.54	Facility	26	$38.02	$52.48	$57.54
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $85.11	Professional		$85.11	$85.11	$85.11
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $39.81 / $57.54	Professional	26	$30.90	$39.81	$57.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $114.82 / $138.04	Professional	TC	$77.62	$114.82	$138.04
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $6.92 / $32.36 / $46.77	Facility	26	$6.92	$32.36	$46.77
Providence Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $194.98 / $281.84	Professional		$147.91	$194.98	$281.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $51.29 / $81.28	Professional	26	$35.48	$51.29	$81.28
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $134.90 / $199.53	Professional	TC	$89.13	$134.90	$199.53
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.14 / $851.14 / $851.14	Facility	26	$851.14	$851.14	$851.14
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $199.53 / $263.03	Professional		$165.96	$199.53	$263.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $58.88 / $77.62	Professional	26	$40.74	$58.88	$77.62
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $141.25 / $186.21	Professional	TC	$123.03	$141.25	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $104.71 / $257.04	Professional		$85.11	$104.71	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $33.11 / $74.13	Professional	26	$23.44	$33.11	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $77.62 / $181.97	Professional	TC	$60.26	$77.62	$181.97