Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.01 / $57.05 / $116.93	Facility	26	$43.01	$57.05	$116.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.57 / $132.34 / $443.92	Professional		$84.57	$132.34	$443.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.87 / $32.04 / $133.00	Professional	26	$22.87	$32.04	$133.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.33 / $95.75 / $223.47	Professional	TC	$66.33	$95.75	$223.47
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.92 / $28.92 / $28.92	Facility	26	$28.92	$28.92	$28.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.37 / $243.64 / $367.00	Professional		$106.37	$243.64	$367.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.08 / $49.40 / $73.22	Professional	26	$29.08	$49.40	$73.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.49 / $194.47 / $294.02	Professional	TC	$83.49	$194.47	$294.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $240.71 / $286.51 / $332.71	Professional		$240.71	$286.51	$332.71
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.89 / $57.21 / $64.41	Professional	26	$47.89	$57.21	$64.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $191.35 / $228.48 / $268.27	Professional	TC	$191.35	$228.48	$268.27
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $137.00 / $206.61 / $387.24	Professional		$137.00	$206.61	$387.24
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.03 / $48.51 / $77.25	Professional	26	$40.03	$48.51	$77.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $106.26 / $193.37 / $307.66	Professional	TC	$106.26	$193.37	$307.66
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $37.24 / $49.35 / $50.92	Facility	26	$37.24	$49.35	$50.92
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $30.55 / $39.52 / $53.39	Professional	26	$30.55	$39.52	$53.39
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $84.82 / $127.88 / $200.57	Professional	TC	$84.82	$127.88	$200.57
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $28.92 / $28.92 / $28.92	Facility	26	$28.92	$28.92	$28.92
Providence Facility/Professional Professional Modifier Low / Median / High Price $171.36 / $271.60 / $368.43	Professional		$171.36	$271.60	$368.43
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.43 / $51.02 / $73.75	Professional	26	$34.43	$51.02	$73.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $114.05 / $204.18 / $294.02	Professional	TC	$114.05	$204.18	$294.02
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $175.10 / $259.93 / $361.95	Professional		$175.10	$259.93	$361.95
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $45.49 / $53.77 / $71.93	Professional	26	$45.49	$53.77	$71.93
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $139.99 / $207.80 / $289.93	Professional	TC	$139.99	$207.80	$289.93
United Facility/Professional Professional Modifier Low / Median / High Price $109.44 / $149.40 / $375.66	Professional		$109.44	$149.40	$375.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.03 / $35.19 / $77.41	Professional	26	$27.03	$35.19	$77.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.54 / $107.87 / $298.25	Professional	TC	$96.54	$107.87	$298.25