Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.84 / $73.72 / $165.03	Facility	26	$50.84	$73.72	$165.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $62.40 / $111.53 / $824.90	Professional		$62.40	$111.53	$824.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.73 / $125.10 / $820.00	Professional	26	$28.73	$125.10	$820.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.34 / $44.94 / $173.00	Professional	TC	$35.34	$44.94	$173.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $103.31 / $146.43 / $187.68	Professional		$103.31	$146.43	$187.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.62 / $69.54 / $89.42	Professional	26	$46.62	$69.54	$89.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.44 / $76.89 / $99.32	Professional	TC	$54.44	$76.89	$99.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $133.65 / $157.44 / $181.04	Professional		$133.65	$157.44	$181.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.46 / $76.17 / $85.96	Professional	26	$63.46	$76.17	$85.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $70.17 / $80.97 / $95.05	Professional	TC	$70.17	$80.97	$95.05
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $99.96 / $127.30 / $200.28	Professional		$99.96	$127.30	$200.28
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.83 / $73.53 / $105.03	Professional	26	$52.83	$73.53	$105.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.31 / $78.30 / $100.65	Professional	TC	$58.31	$78.30	$100.65
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $44.57 / $60.30 / $64.98	Facility	26	$44.57	$60.30	$64.98
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $46.21 / $51.35 / $57.29	Professional		$46.21	$51.35	$57.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $36.18 / $54.86 / $69.00	Professional	26	$36.18	$54.86	$69.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $39.40 / $56.14 / $74.25	Professional	TC	$39.40	$56.14	$74.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $110.92 / $146.61 / $192.06	Professional		$110.92	$146.61	$192.06
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.04 / $62.66 / $89.39	Professional	26	$43.04	$62.66	$89.39
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $43.49 / $76.16 / $96.73	Professional	TC	$43.49	$76.16	$96.73
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $422.45 / $422.45 / $422.45	Facility	26	$422.45	$422.45	$422.45
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $119.56 / $153.75 / $186.66	Professional		$119.56	$153.75	$186.66
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $58.49 / $75.67 / $92.86	Professional	26	$58.49	$75.67	$92.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $62.37 / $78.12 / $93.80	Professional	TC	$62.37	$78.12	$93.80
United Facility/Professional Professional Modifier Low / Median / High Price $79.50 / $90.92 / $209.60	Professional		$79.50	$90.92	$209.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.78 / $41.95 / $104.27	Professional	26	$38.78	$41.95	$104.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.07 / $43.89 / $105.33	Professional	TC	$39.07	$43.89	$105.33