Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.30 / $81.95 / $152.00	Facility	26	$56.30	$81.95	$152.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.43 / $182.30 / $534.00	Professional		$93.43	$182.30	$534.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.61 / $62.30 / $224.52	Professional	26	$36.61	$62.30	$224.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.82 / $70.98 / $193.54	Professional	TC	$56.82	$70.98	$193.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $116.17 / $232.63 / $324.52	Professional		$116.17	$232.63	$324.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.26 / $84.51 / $121.50	Professional	26	$47.26	$84.51	$121.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.18 / $153.10 / $206.51	Professional	TC	$78.18	$153.10	$206.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $208.40 / $242.87 / $293.58	Professional		$208.40	$242.87	$293.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.18 / $90.02 / $104.03	Professional	26	$76.18	$90.02	$104.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $131.16 / $153.47 / $189.55	Professional	TC	$131.16	$153.47	$189.55
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $165.78 / $188.10 / $334.47	Professional		$165.78	$188.10	$334.47
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.05 / $77.59 / $127.33	Professional	26	$64.05	$77.59	$127.33
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.41 / $135.80 / $217.50	Professional	TC	$109.41	$135.80	$217.50
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $60.76 / $79.61 / $84.32	Facility	26	$60.76	$79.61	$84.32
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $50.00 / $71.81 / $90.00	Professional	26	$50.00	$71.81	$90.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $83.62 / $118.56 / $152.76	Professional	TC	$83.62	$118.56	$152.76
Providence Facility/Professional Professional Modifier Low / Median / High Price $194.11 / $241.60 / $320.10	Professional		$194.11	$241.60	$320.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $54.81 / $87.95 / $118.99	Professional	26	$54.81	$87.95	$118.99
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $94.22 / $158.47 / $206.51	Professional	TC	$94.22	$158.47	$206.51
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 $202.95 / $264.08 / $311.73	Professional		$202.95	$264.08	$311.73
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $74.11 / $97.13 / $115.08	Professional	26	$74.11	$97.13	$115.08
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $127.60 / $166.96 / $198.03	Professional	TC	$127.60	$166.96	$198.03
United Facility/Professional Professional Modifier Low / Median / High Price $115.13 / $129.65 / $329.73	Professional		$115.13	$129.65	$329.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.31 / $70.81 / $123.85	Professional	26	$43.31	$70.81	$123.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.81 / $78.98 / $205.69	Professional	TC	$71.81	$78.98	$205.69