Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $74.13 / $83.18	Facility	26	$53.70	$74.13	$83.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $87.10 / $204.17	Professional		$67.61	$87.10	$204.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $41.69 / $114.82	Professional	26	$27.54	$41.69	$114.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $52.48 / $102.33	Professional	TC	$39.81	$52.48	$102.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $158.49 / $234.42	Professional		$87.10	$158.49	$234.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $61.66 / $95.50	Professional	26	$37.15	$61.66	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $95.50 / $144.54	Professional	TC	$51.29	$95.50	$144.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $173.78 / $218.78	Professional		$154.88	$173.78	$218.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $70.79 / $85.11	Professional	26	$60.26	$70.79	$85.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $107.15 / $134.90	Professional	TC	$91.20	$107.15	$134.90
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $66.07 / $91.20	Facility	26	$53.70	$66.07	$91.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $165.96 / $251.19	Professional		$91.20	$165.96	$251.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $67.61 / $97.72	Professional	26	$36.31	$67.61	$97.72
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $97.72 / $144.54	Professional	TC	$52.48	$97.72	$144.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $64.57 / $66.07	Facility	26	$53.70	$64.57	$66.07
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $53.70 / $66.07	Professional	26	$38.90	$53.70	$66.07
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $95.50 / $95.50	Professional	TC	$79.43	$95.50	$95.50
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $8.13 / $38.02 / $53.70	Facility	26	$8.13	$38.02	$53.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $177.83 / $245.47	Professional		$138.04	$177.83	$245.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $72.44 / $100.00	Professional	26	$44.67	$72.44	$100.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $107.15 / $158.49	Professional	TC	$64.57	$107.15	$158.49
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $169.82 / $223.87	Professional		$141.25	$169.82	$223.87
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $70.79 / $91.20	Professional	26	$58.88	$70.79	$91.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $102.33 / $134.90	Professional	TC	$81.28	$102.33	$134.90
United Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $102.33 / $218.78	Professional		$81.28	$102.33	$218.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $43.65 / $91.20	Professional	26	$34.67	$43.65	$91.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $58.88 / $131.83	Professional	TC	$47.86	$58.88	$131.83