Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $74.56 / $168.00 / $2,613.71	Facility		$74.56	$168.00	$2,613.71
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.61 / $28.98 / $62.93	Facility	26	$22.61	$28.98	$62.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.91 / $40.44 / $156.04	Professional		$30.91	$40.44	$156.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.00 / $15.83 / $63.50	Professional	26	$13.00	$15.83	$63.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $24.52 / $60.61	Professional	TC	$17.89	$24.52	$60.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.36 / $77.47 / $109.85	Professional		$36.36	$77.47	$109.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.67 / $28.90 / $40.32	Professional	26	$16.67	$28.90	$40.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.25 / $49.39 / $72.77	Professional	TC	$20.25	$49.39	$72.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $73.31 / $89.64 / $103.20	Professional		$73.31	$89.64	$103.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.17 / $30.28 / $34.09	Professional	26	$25.17	$30.28	$34.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.85 / $58.89 / $69.11	Professional	TC	$47.85	$58.89	$69.11
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $38.04 / $67.62 / $95.34	Facility		$38.04	$67.62	$95.34
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $52.50 / $65.09 / $122.02	Professional		$52.50	$65.09	$122.02
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.35 / $28.38 / $42.44	Professional	26	$21.35	$28.38	$42.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.29 / $52.89 / $79.56	Professional	TC	$36.29	$52.89	$79.56
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $43.61 / $68.34 / $77.05	Facility		$43.61	$68.34	$77.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.09 / $26.25 / $28.81	Facility	26	$20.09	$26.25	$28.81
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.29 / $25.12 / $30.66	Professional	26	$17.29	$25.12	$30.66
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $23.04 / $33.60 / $49.58	Professional	TC	$23.04	$33.60	$49.58
Providence Facility/Professional Facility Modifier Low / Median / High Price $40.47 / $77.34 / $111.55	Facility		$40.47	$77.34	$111.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $56.00 / $83.95 / $111.55	Professional		$56.00	$83.95	$111.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $18.12 / $29.74 / $40.32	Professional	26	$18.12	$29.74	$40.32
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $25.29 / $49.90 / $71.51	Professional	TC	$25.29	$49.90	$71.51
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $65.80 / $88.88 / $111.81	Professional		$65.80	$88.88	$111.81
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $25.14 / $32.86 / $39.79	Professional	26	$25.14	$32.86	$39.79
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $40.76 / $58.43 / $72.01	Professional	TC	$40.76	$58.43	$72.01
United Facility/Professional Professional Modifier Low / Median / High Price $32.70 / $44.60 / $122.26	Professional		$32.70	$44.60	$122.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.80 / $16.94 / $43.51	Professional	26	$14.80	$16.94	$43.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.61 / $29.08 / $80.87	Professional	TC	$17.61	$29.08	$80.87