Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.03 / $67.59 / $136.57	Facility	26	$60.03	$67.59	$136.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.48 / $127.03 / $508.00	Professional		$73.48	$127.03	$508.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $35.86 / $139.00	Professional	26	$24.78	$35.86	$139.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.13 / $90.40 / $316.00	Professional	TC	$48.13	$90.40	$316.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.27 / $31.27 / $31.27	Facility	26	$31.27	$31.27	$31.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.88 / $180.35 / $300.43	Professional		$91.88	$180.35	$300.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.19 / $48.59 / $79.65	Professional	26	$26.19	$48.59	$79.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.72 / $132.24 / $216.06	Professional	TC	$62.72	$132.24	$216.06
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $201.54 / $225.07 / $277.33	Professional		$201.54	$225.07	$277.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.41 / $60.33 / $70.51	Professional	26	$52.41	$60.33	$70.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $147.52 / $167.44 / $206.79	Professional	TC	$147.52	$167.44	$206.79
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $163.32 / $204.96 / $314.13	Professional		$163.32	$204.96	$314.13
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.76 / $62.28 / $86.99	Professional	26	$43.76	$62.28	$86.99
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $119.56 / $158.94 / $229.77	Professional	TC	$119.56	$158.94	$229.77
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $39.72 / $54.03 / $54.94	Facility	26	$39.72	$54.03	$54.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $35.26 / $46.53 / $57.38	Professional	26	$35.26	$46.53	$57.38
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $92.57 / $124.26 / $156.78	Professional	TC	$92.57	$124.26	$156.78
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $31.27 / $31.27 / $31.27	Facility	26	$31.27	$31.27	$31.27
Providence Facility/Professional Professional Modifier Low / Median / High Price $145.22 / $219.56 / $287.37	Professional		$145.22	$219.56	$287.37
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $27.59 / $49.10 / $79.65	Professional	26	$27.59	$49.10	$79.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $79.65 / $133.46 / $222.24	Professional	TC	$79.65	$133.46	$222.24
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $209.36 / $209.36 / $209.36	Facility	26	$209.36	$209.36	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $184.94 / $213.36 / $289.52	Professional		$184.94	$213.36	$289.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.20 / $58.01 / $78.64	Professional	26	$49.20	$58.01	$78.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $135.26 / $157.44 / $211.76	Professional	TC	$135.26	$157.44	$211.76
United Facility/Professional Professional Modifier Low / Median / High Price $86.13 / $138.40 / $304.89	Professional		$86.13	$138.40	$304.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.02 / $32.35 / $83.96	Professional	26	$25.02	$32.35	$83.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.50 / $90.55 / $220.15	Professional	TC	$61.50	$90.55	$220.15