Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.66 / $59.42 / $131.57	Facility	26	$43.66	$59.42	$131.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $80.93 / $110.69 / $286.36	Professional		$80.93	$110.69	$286.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.69 / $29.88 / $75.94	Professional	26	$21.69	$29.88	$75.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.24 / $82.59 / $200.05	Professional	TC	$59.24	$82.59	$200.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.07 / $30.07 / $30.07	Facility	26	$30.07	$30.07	$30.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $98.57 / $192.74 / $275.74	Professional		$98.57	$192.74	$275.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.07 / $51.08 / $74.37	Professional	26	$29.07	$51.08	$74.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.80 / $140.40 / $207.54	Professional	TC	$70.80	$140.40	$207.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $195.57 / $232.53 / $269.20	Professional		$195.57	$232.53	$269.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $49.82 / $59.56 / $67.06	Professional	26	$49.82	$59.56	$67.06
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $144.22 / $172.21 / $202.17	Professional	TC	$144.22	$172.21	$202.17
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $146.50 / $169.00 / $299.11	Professional		$146.50	$169.00	$299.11
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.63 / $52.74 / $80.31	Professional	26	$41.63	$52.74	$80.31
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $116.89 / $149.47 / $224.67	Professional	TC	$116.89	$149.47	$224.67
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.71 / $51.35 / $52.93	Facility	26	$38.71	$51.35	$52.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $43.85 / $53.90	Professional	26	$31.76	$43.85	$53.90
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $79.23 / $109.01 / $142.88	Professional	TC	$79.23	$109.01	$142.88
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $30.07 / $30.07 / $30.07	Facility	26	$30.07	$30.07	$30.07
Providence Facility/Professional Professional Modifier Low / Median / High Price $148.05 / $214.50 / $283.10	Professional		$148.05	$214.50	$283.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $35.50 / $52.41 / $76.26	Professional	26	$35.50	$52.41	$76.26
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $93.58 / $146.88 / $207.54	Professional	TC	$93.58	$146.88	$207.54
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 $179.55 / $204.82 / $272.94	Professional		$179.55	$204.82	$272.94
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $47.28 / $54.48 / $74.84	Professional	26	$47.28	$54.48	$74.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $129.47 / $151.38 / $201.07	Professional	TC	$129.47	$151.38	$201.07
United Facility/Professional Professional Modifier Low / Median / High Price $87.68 / $108.19 / $310.79	Professional		$87.68	$108.19	$310.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.41 / $31.16 / $81.65	Professional	26	$27.41	$31.16	$81.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.66 / $80.59 / $195.05	Professional	TC	$60.66	$80.59	$195.05