Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.04 / $65.95 / $133.00	Facility	26	$42.04	$65.95	$133.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.63 / $138.40 / $605.00	Professional		$102.63	$138.40	$605.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.91 / $44.28 / $164.00	Professional	26	$28.91	$44.28	$164.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.68 / $97.20 / $189.89	Professional	TC	$72.68	$97.20	$189.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $88.51 / $204.59 / $295.01	Professional		$88.51	$204.59	$295.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.79 / $62.67 / $88.45	Professional	26	$34.79	$62.67	$88.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.09 / $146.93 / $207.49	Professional	TC	$56.09	$146.93	$207.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $191.10 / $222.71 / $270.37	Professional		$191.10	$222.71	$270.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.73 / $67.12 / $77.47	Professional	26	$56.73	$67.12	$77.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $133.51 / $156.19 / $192.90	Professional	TC	$133.51	$156.19	$192.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $115.80 / $178.50 / $309.06	Professional		$115.80	$178.50	$309.06
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.03 / $58.80 / $95.48	Professional	26	$48.03	$58.80	$95.48
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $111.54 / $142.56 / $221.73	Professional	TC	$111.54	$142.56	$221.73
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $44.59 / $59.37 / $61.64	Facility	26	$44.59	$59.37	$61.64
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $36.58 / $51.22 / $62.84	Professional	26	$36.58	$51.22	$62.84
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $46.51 / $84.99 / $154.77	Professional	TC	$46.51	$84.99	$154.77
Providence Facility/Professional Professional Modifier Low / Median / High Price $128.04 / $220.40 / $293.58	Professional		$128.04	$220.40	$293.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $40.22 / $66.18 / $87.55	Professional	26	$40.22	$66.18	$87.55
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $57.44 / $156.11 / $207.49	Professional	TC	$57.44	$156.11	$207.49
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 $180.90 / $237.68 / $288.04	Professional		$180.90	$237.68	$288.04
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $55.74 / $73.02 / $86.22	Professional	26	$55.74	$73.02	$86.22
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $127.23 / $170.98 / $201.82	Professional	TC	$127.23	$170.98	$201.82
United Facility/Professional Professional Modifier Low / Median / High Price $69.62 / $112.46 / $305.95	Professional		$69.62	$112.46	$305.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.98 / $35.56 / $93.02	Professional	26	$31.98	$35.56	$93.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.27 / $85.17 / $212.94	Professional	TC	$42.27	$85.17	$212.94