Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.03 / $79.98 / $145.35	Facility	26	$51.03	$79.98	$145.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.68 / $120.28 / $469.00	Professional		$82.68	$120.28	$469.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.34 / $50.96 / $188.00	Professional	26	$33.34	$50.96	$188.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.45 / $57.70 / $136.86	Professional	TC	$46.45	$57.70	$136.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $99.14 / $184.02 / $252.73	Professional		$99.14	$184.02	$252.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.36 / $75.95 / $108.86	Professional	26	$42.36	$75.95	$108.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.06 / $108.97 / $146.52	Professional	TC	$58.06	$108.97	$146.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $164.52 / $191.73 / $230.83	Professional		$164.52	$191.73	$230.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.48 / $80.95 / $93.52	Professional	26	$68.48	$80.95	$93.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $95.05 / $111.19 / $137.32	Professional	TC	$95.05	$111.19	$137.32
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $133.75 / $153.60 / $256.20	Professional		$133.75	$153.60	$256.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.63 / $69.95 / $114.57	Professional	26	$57.63	$69.95	$114.57
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.53 / $100.50 / $158.10	Professional	TC	$79.53	$100.50	$158.10
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $55.37 / $71.61 / $75.70	Facility	26	$55.37	$71.61	$75.70
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $75.14 / $75.14 / $75.14	Professional		$75.14	$75.14	$75.14
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $47.46 / $63.80 / $80.23	Professional	26	$47.46	$63.80	$80.23
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $60.90 / $82.94 / $105.85	Professional	TC	$60.90	$82.94	$105.85
Providence Facility/Professional Professional Modifier Low / Median / High Price $149.27 / $186.72 / $248.60	Professional		$149.27	$186.72	$248.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $49.77 / $79.15 / $107.54	Professional	26	$49.77	$79.15	$107.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $63.42 / $111.07 / $146.52	Professional	TC	$63.42	$111.07	$146.52
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 $154.96 / $200.68 / $238.77	Professional		$154.96	$200.68	$238.77
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $67.38 / $87.96 / $104.53	Professional	26	$67.38	$87.96	$104.53
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $87.59 / $113.10 / $136.44	Professional	TC	$87.59	$113.10	$136.44
United Facility/Professional Professional Modifier Low / Median / High Price $88.42 / $114.95 / $268.12	Professional		$88.42	$114.95	$268.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.34 / $43.35 / $111.89	Professional	26	$39.34	$43.35	$111.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.08 / $57.73 / $146.66	Professional	TC	$49.08	$57.73	$146.66