Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.00 / $62.71 / $263.56	Facility	26	$43.00	$62.71	$263.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.59 / $138.22 / $449.00	Professional		$82.59	$138.22	$449.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.57 / $52.40 / $159.19	Professional	26	$28.57	$52.40	$159.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.88 / $67.39 / $172.97	Professional	TC	$51.88	$67.39	$172.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.61 / $176.22 / $238.96	Professional		$93.61	$176.22	$238.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.26 / $64.11 / $90.39	Professional	26	$35.26	$64.11	$90.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $59.57 / $112.01 / $149.47	Professional	TC	$59.57	$112.01	$149.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.79 / $178.18 / $217.85	Professional		$154.79	$178.18	$217.85
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.05 / $68.62 / $79.26	Professional	26	$58.05	$68.62	$79.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $95.91 / $112.22 / $138.59	Professional	TC	$95.91	$112.22	$138.59
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $129.16 / $140.90 / $249.06	Professional		$129.16	$140.90	$249.06
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.10 / $64.88 / $97.61	Professional	26	$49.10	$64.88	$97.61
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $80.06 / $104.94 / $159.15	Professional	TC	$80.06	$104.94	$159.15
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $45.57 / $60.70 / $62.98	Facility	26	$45.57	$60.70	$62.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $37.20 / $53.58 / $66.97	Professional	26	$37.20	$53.58	$66.97
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $62.16 / $89.11 / $116.82	Professional	TC	$62.16	$89.11	$116.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $143.96 / $179.82 / $236.68	Professional		$143.96	$179.82	$236.68
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.07 / $67.72 / $89.51	Professional	26	$41.07	$67.72	$89.51
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $68.86 / $115.43 / $149.47	Professional	TC	$68.86	$115.43	$149.47
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 $148.22 / $195.86 / $232.14	Professional		$148.22	$195.86	$232.14
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.12 / $73.84 / $88.12	Professional	26	$56.12	$73.84	$88.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $94.33 / $122.01 / $144.02	Professional	TC	$94.33	$122.01	$144.02
United Facility/Professional Professional Modifier Low / Median / High Price $85.53 / $97.07 / $244.95	Professional		$85.53	$97.07	$244.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.60 / $36.35 / $98.96	Professional	26	$32.60	$36.35	$98.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.10 / $64.63 / $151.07	Professional	TC	$52.10	$64.63	$151.07