Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.10 / $47.00 / $104.79	Facility	26	$29.10	$47.00	$104.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.15 / $75.01 / $176.59	Professional		$50.15	$75.01	$176.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.93 / $23.80 / $57.03	Professional	26	$16.93	$23.80	$57.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.22 / $50.81 / $123.36	Professional	TC	$33.22	$50.81	$123.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.92 / $23.92 / $23.92	Facility	26	$23.92	$23.92	$23.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $68.72 / $127.72 / $188.62	Professional		$68.72	$127.72	$188.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.42 / $41.99 / $61.65	Professional	26	$24.42	$41.99	$61.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.11 / $87.52 / $126.10	Professional	TC	$46.11	$87.52	$126.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $129.21 / $153.33 / $177.19	Professional		$129.21	$153.33	$177.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.69 / $47.43 / $53.41	Professional	26	$39.69	$47.43	$53.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $88.30 / $105.43 / $123.76	Professional	TC	$88.30	$105.43	$123.76
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $99.68 / $114.18 / $198.24	Professional		$99.68	$114.18	$198.24
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.08 / $43.04 / $63.03	Professional	26	$33.08	$43.04	$63.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $71.51 / $94.36 / $135.21	Professional	TC	$71.51	$94.36	$135.21
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $31.85 / $40.90 / $43.55	Facility	26	$31.85	$40.90	$43.55
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $26.13 / $37.39 / $45.83	Professional	26	$26.13	$37.39	$45.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $53.35 / $72.67 / $91.79	Professional	TC	$53.35	$72.67	$91.79
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $23.92 / $23.92 / $23.92	Facility	26	$23.92	$23.92	$23.92
Providence Facility/Professional Professional Modifier Low / Median / High Price $104.72 / $141.82 / $189.15	Professional		$104.72	$141.82	$189.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.09 / $43.20 / $62.53	Professional	26	$28.09	$43.20	$62.53
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $60.25 / $89.89 / $126.10	Professional	TC	$60.25	$89.89	$126.10
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 $116.71 / $136.22 / $178.03	Professional		$116.71	$136.22	$178.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.11 / $45.90 / $58.75	Professional	26	$37.11	$45.90	$58.75
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $79.59 / $93.13 / $121.31	Professional	TC	$79.59	$93.13	$121.31
United Facility/Professional Professional Modifier Low / Median / High Price $64.23 / $78.29 / $202.02	Professional		$64.23	$78.29	$202.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.74 / $25.61 / $64.52	Professional	26	$22.74	$25.61	$64.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.32 / $53.95 / $118.86	Professional	TC	$41.32	$53.95	$118.86