Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $85.11 / $100.00	Facility	26	$60.26	$85.11	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $100.00 / $426.58	Professional		$72.44	$100.00	$426.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $48.98 / $199.53	Professional	26	$35.48	$48.98	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $56.23 / $213.80	Professional	TC	$32.36	$56.23	$213.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $154.88 / $245.47	Professional		$91.20	$154.88	$245.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $70.79 / $109.65	Professional	26	$40.74	$70.79	$109.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $83.18 / $138.04	Professional	TC	$43.65	$83.18	$138.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $169.82 / $213.80	Professional		$151.36	$169.82	$213.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $79.43 / $95.50	Professional	26	$70.79	$79.43	$95.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $91.20 / $114.82	Professional	TC	$72.44	$91.20	$114.82
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $158.49 / $251.19	Professional		$97.72	$158.49	$251.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $75.86 / $112.20	Professional	26	$44.67	$75.86	$112.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $85.11 / $162.18	Professional	TC	$56.23	$85.11	$162.18
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $74.13 / $75.86	Facility	26	$61.66	$74.13	$75.86
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $67.61 / $83.18	Professional	26	$45.71	$67.61	$83.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $61.66 / $93.33	Professional	TC	$40.74	$61.66	$93.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $42.66 / $61.66	Facility	26	$9.12	$42.66	$61.66
Providence Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $158.49 / $223.87	Professional		$123.03	$158.49	$223.87
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $77.62 / $109.65	Professional	26	$51.29	$77.62	$109.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $83.18 / $123.03	Professional	TC	$47.86	$83.18	$123.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $151.36 / $199.53	Professional		$123.03	$151.36	$199.53
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $79.43 / $102.33	Professional	26	$67.61	$79.43	$102.33
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $75.86 / $104.71	Professional	TC	$57.54	$75.86	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $117.49 / $208.93	Professional		$61.66	$117.49	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $50.12 / $112.20	Professional	26	$33.88	$50.12	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $60.26 / $112.20	Professional	TC	$27.54	$60.26	$112.20