Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.45 / $100.05 / $188.40	Facility	26	$81.45	$100.05	$188.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.00 / $101.64 / $420.00	Professional		$79.00	$101.64	$420.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.07 / $57.29 / $212.00	Professional	26	$34.07	$57.29	$212.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.10 / $59.18 / $285.00	Professional	TC	$37.10	$59.18	$285.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.19 / $43.19 / $43.19	Facility	26	$43.19	$43.19	$43.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $98.10 / $152.07 / $222.60	Professional		$98.10	$152.07	$222.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.64 / $73.43 / $108.72	Professional	26	$42.64	$73.43	$108.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.97 / $74.22 / $119.97	Professional	TC	$43.97	$74.22	$119.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $156.59 / $185.10 / $212.40	Professional		$156.59	$185.10	$212.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $71.59 / $85.60 / $96.37	Professional	26	$71.59	$85.60	$96.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $82.77 / $98.83 / $116.03	Professional	TC	$82.77	$98.83	$116.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $113.68 / $139.33 / $245.52	Professional		$113.68	$139.33	$245.52
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $59.78 / $77.73 / $113.85	Professional	26	$59.78	$77.73	$113.85
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $67.25 / $89.67 / $133.69	Professional	TC	$67.25	$89.67	$133.69
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $55.37 / $73.81 / $76.38	Facility	26	$55.37	$73.81	$76.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $45.02 / $69.37 / $80.37	Professional	26	$45.02	$69.37	$80.37
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $41.27 / $64.31 / $103.18	Professional	TC	$41.27	$64.31	$103.18
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $43.19 / $43.19 / $43.19	Facility	26	$43.19	$43.19	$43.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $118.59 / $163.80 / $213.47	Professional		$118.59	$163.80	$213.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.74 / $76.64 / $110.14	Professional	26	$50.74	$76.64	$110.14
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $46.21 / $80.02 / $118.06	Professional	TC	$46.21	$80.02	$118.06
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $131.57 / $158.06 / $206.52	Professional		$131.57	$158.06	$206.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $67.03 / $79.95 / $106.12	Professional	26	$67.03	$79.95	$106.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $62.53 / $81.88 / $104.80	Professional	TC	$62.53	$81.88	$104.80
United Facility/Professional Professional Modifier Low / Median / High Price $61.63 / $112.74 / $209.81	Professional		$61.63	$112.74	$209.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.21 / $44.74 / $116.02	Professional	26	$34.21	$44.74	$116.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.85 / $59.40 / $127.65	Professional	TC	$26.85	$59.40	$127.65