Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $69.18 / $109.65	Facility	26	$41.69	$69.18	$109.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $104.71 / $446.68	Professional		$54.95	$104.71	$446.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $45.71 / $141.25	Professional	26	$24.55	$45.71	$141.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.02 / $32.36 / $97.72	Professional	TC	$12.02	$32.36	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $128.82 / $239.88	Professional		$72.44	$128.82	$239.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $69.18 / $117.49	Professional	26	$33.88	$69.18	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $34.67 / $169.82	Professional	TC	$15.85	$34.67	$169.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $114.82 / $138.04	Professional		$89.13	$114.82	$138.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $89.13 / $107.15	Professional	26	$69.18	$89.13	$107.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $23.44 / $29.51	Professional	TC	$19.05	$23.44	$29.51
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $58.88 / $100.00	Facility	26	$41.69	$58.88	$100.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $120.23 / $190.55	Professional		$70.79	$120.23	$190.55
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $87.10 / $125.89	Professional	26	$38.90	$87.10	$125.89
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $25.12 / $70.79	Professional	TC	$18.20	$25.12	$70.79
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $70.79 / $85.11	Facility	26	$51.29	$70.79	$85.11
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $83.18 / $83.18	Professional		$83.18	$83.18	$83.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $54.95 / $85.11	Professional	26	$36.31	$54.95	$85.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $109.65 / $169.82	Professional	TC	$20.89	$109.65	$169.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $134.90 / $229.09	Professional		$97.72	$134.90	$229.09
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $70.79 / $112.20	Professional	26	$44.67	$70.79	$112.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $70.79 / $190.55	Professional	TC	$18.62	$70.79	$190.55
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $131.83 / $208.93	Professional		$97.72	$131.83	$208.93
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $81.28 / $114.82	Professional	26	$56.23	$81.28	$114.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $37.15 / $141.25	Professional	TC	$20.89	$37.15	$141.25
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $117.49 / $223.87	Professional		$67.61	$117.49	$223.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $39.81 / $95.50	Professional	26	$31.62	$39.81	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $72.44 / $134.90	Professional	TC	$23.99	$72.44	$134.90