Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.54 / $29.30 / $59.20	Facility	26	$25.54	$29.30	$59.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.17 / $117.91 / $371.00	Professional		$84.17	$117.91	$371.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.53 / $15.10 / $86.00	Professional	26	$10.53	$15.10	$86.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.93 / $102.81 / $285.00	Professional	TC	$72.93	$102.81	$285.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.50 / $13.50 / $13.50	Facility	26	$13.50	$13.50	$13.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.79 / $202.14 / $314.64	Professional		$112.79	$202.14	$314.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.26 / $21.00 / $34.02	Professional	26	$11.26	$21.00	$34.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.83 / $181.41 / $282.66	Professional	TC	$100.83	$181.41	$282.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $197.96 / $231.41 / $275.31	Professional		$197.96	$231.41	$275.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.45 / $25.89 / $30.19	Professional	26	$22.45	$25.89	$30.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $174.84 / $205.54 / $245.11	Professional	TC	$174.84	$205.54	$245.11
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $164.97 / $201.00 / $318.29	Professional		$164.97	$201.00	$318.29
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.68 / $24.30 / $35.58	Professional	26	$18.68	$24.30	$35.58
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $141.44 / $201.44 / $284.64	Professional	TC	$141.44	$201.44	$284.64
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.14 / $23.13 / $23.45	Facility	26	$17.14	$23.13	$23.45
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $89.83 / $89.83 / $89.83	Professional		$89.83	$89.83	$89.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $21.00 / $24.67	Professional	26	$14.07	$21.00	$24.67
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $129.81 / $180.77 / $250.22	Professional	TC	$129.81	$180.77	$250.22
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.50 / $13.50 / $13.50	Facility	26	$13.50	$13.50	$13.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $166.92 / $241.32 / $304.85	Professional		$166.92	$241.32	$304.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.96 / $21.00 / $34.42	Professional	26	$11.96	$21.00	$34.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $100.83 / $185.00 / $282.85	Professional	TC	$100.83	$185.00	$282.85
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $209.36 / $209.36 / $209.36	Facility	26	$209.36	$209.36	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $188.53 / $240.72 / $298.45	Professional		$188.53	$240.72	$298.45
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $20.95 / $24.76 / $33.15	Professional	26	$20.95	$24.76	$33.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $167.58 / $217.40 / $265.30	Professional	TC	$167.58	$217.40	$265.30
United Facility/Professional Professional Modifier Low / Median / High Price $97.44 / $148.38 / $332.31	Professional		$97.44	$148.38	$332.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.68 / $13.26 / $36.17	Professional	26	$10.68	$13.26	$36.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.74 / $132.71 / $295.11	Professional	TC	$86.74	$132.71	$295.11