Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $39.52 / $87.96	Facility	26	$30.20	$39.52	$87.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.09 / $128.18 / $559.02	Professional		$95.09	$128.18	$559.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $23.98 / $96.00	Professional	26	$16.60	$23.98	$96.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.56 / $104.12 / $203.08	Professional	TC	$69.56	$104.12	$203.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.50 / $20.50 / $20.50	Facility	26	$20.50	$20.50	$20.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $105.54 / $203.02 / $286.04	Professional		$105.54	$203.02	$286.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.93 / $34.97 / $51.86	Professional	26	$20.93	$34.97	$51.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.61 / $169.21 / $235.89	Professional	TC	$84.61	$169.21	$235.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $191.45 / $228.20 / $264.95	Professional		$191.45	$228.20	$264.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.06 / $40.63 / $45.75	Professional	26	$34.06	$40.63	$45.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $156.34 / $186.68 / $219.18	Professional	TC	$156.34	$186.68	$219.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $151.76 / $181.56 / $308.75	Professional		$151.76	$181.56	$308.75
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.83 / $38.08 / $57.30	Professional	26	$28.83	$38.08	$57.30
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $126.49 / $168.69 / $251.44	Professional	TC	$126.49	$168.69	$251.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $26.46 / $35.11 / $36.18	Facility	26	$26.46	$35.11	$36.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $21.71 / $31.86 / $37.79	Professional	26	$21.71	$31.86	$37.79
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $84.10 / $125.12 / $180.65	Professional	TC	$84.10	$125.12	$180.65
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $20.50 / $20.50 / $20.50	Facility	26	$20.50	$20.50	$20.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $137.66 / $222.74 / $292.60	Professional		$137.66	$222.74	$292.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.46 / $36.99 / $52.12	Professional	26	$24.46	$36.99	$52.12
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $101.85 / $175.16 / $238.96	Professional	TC	$101.85	$175.16	$238.96
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $178.49 / $217.16 / $286.14	Professional		$178.49	$217.16	$286.14
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $31.72 / $37.65 / $50.22	Professional	26	$31.72	$37.65	$50.22
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $142.91 / $180.97 / $235.93	Professional	TC	$142.91	$180.97	$235.93
United Facility/Professional Professional Modifier Low / Median / High Price $79.88 / $118.24 / $312.87	Professional		$79.88	$118.24	$312.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.04 / $23.57 / $54.91	Professional	26	$19.04	$23.57	$54.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.54 / $98.40 / $240.48	Professional	TC	$60.54	$98.40	$240.48