Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.33 / $64.80 / $131.13	Facility	26	$40.33	$64.80	$131.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.68 / $104.55 / $495.00	Professional		$81.68	$104.55	$495.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.89 / $33.45 / $102.18	Professional	26	$19.89	$33.45	$102.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.97 / $75.52 / $175.51	Professional	TC	$53.97	$75.52	$175.51
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.40 / $32.40 / $32.40	Facility	26	$32.40	$32.40	$32.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.55 / $174.64 / $277.83	Professional		$95.55	$174.64	$277.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.43 / $48.02 / $80.72	Professional	26	$25.43	$48.02	$80.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.93 / $129.88 / $199.68	Professional	TC	$68.93	$129.88	$199.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $189.90 / $225.48 / $260.85	Professional		$189.90	$225.48	$260.85
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.36 / $64.98 / $73.16	Professional	26	$54.36	$64.98	$73.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $133.87 / $159.84 / $187.68	Professional	TC	$133.87	$159.84	$187.68
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $140.76 / $163.03 / $302.12	Professional		$140.76	$163.03	$302.12
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.24 / $55.53 / $87.42	Professional	26	$42.24	$55.53	$87.42
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $104.28 / $134.52 / $215.36	Professional	TC	$104.28	$134.52	$215.36
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.92 / $51.86 / $56.95	Facility	26	$33.92	$51.86	$56.95
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $30.60 / $42.01 / $56.95	Professional	26	$30.60	$42.01	$56.95
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $78.79 / $115.64 / $139.84	Professional	TC	$78.79	$115.64	$139.84
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $32.40 / $32.40 / $32.40	Facility	26	$32.40	$32.40	$32.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $147.56 / $210.99 / $283.42	Professional		$147.56	$210.99	$283.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.29 / $52.38 / $82.60	Professional	26	$33.29	$52.38	$82.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $95.82 / $143.47 / $200.60	Professional	TC	$95.82	$143.47	$200.60
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.78 / $851.78 / $851.78	Facility	26	$851.78	$851.78	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $167.28 / $202.94 / $277.35	Professional		$167.28	$202.94	$277.35
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $40.59 / $60.70 / $81.48	Professional	26	$40.59	$60.70	$81.48
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $125.42 / $144.02 / $197.01	Professional	TC	$125.42	$144.02	$197.01
United Facility/Professional Professional Modifier Low / Median / High Price $89.12 / $109.84 / $279.66	Professional		$89.12	$109.84	$279.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.72 / $33.54 / $89.09	Professional	26	$23.72	$33.54	$89.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.02 / $77.23 / $220.67	Professional	TC	$65.02	$77.23	$220.67