Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $51.29 / $147.91	Facility	26	$33.88	$51.29	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $125.89 / $275.42	Professional		$83.18	$125.89	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $33.88 / $89.13	Professional	26	$20.89	$33.88	$89.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $93.33 / $186.21	Professional	TC	$61.66	$93.33	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $114.82 / $190.55	Professional		$47.86	$114.82	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $28.18 / $46.77	Professional	26	$13.18	$28.18	$46.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $87.10 / $147.91	Professional	TC	$33.88	$87.10	$147.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $275.42 / $354.81	Professional		$138.04	$275.42	$354.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $69.18 / $85.11	Professional	26	$33.11	$69.18	$85.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $204.17 / $269.15	Professional	TC	$104.71	$204.17	$269.15
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $34.67 / $67.61	Facility	26	$34.67	$34.67	$67.61
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $229.09 / $407.38	Professional		$114.82	$229.09	$407.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $54.95 / $104.71	Professional	26	$28.18	$54.95	$104.71
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $165.96 / $309.03	Professional	TC	$85.11	$165.96	$309.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $64.57 / $67.61	Facility	26	$53.70	$64.57	$67.61
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $53.70 / $74.13	Professional	26	$40.74	$53.70	$74.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $162.18 / $204.17	Professional	TC	$123.03	$162.18	$204.17
Providence Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $218.78 / $371.54	Professional		$100.00	$218.78	$371.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $33.88 / $77.62	Professional	26	$15.85	$33.88	$77.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $102.33 / $239.88	Professional	TC	$42.66	$102.33	$239.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $275.42 / $426.58	Professional		$234.42	$275.42	$426.58
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $67.61 / $104.71	Professional	26	$57.54	$67.61	$104.71
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $204.17 / $323.59	Professional	TC	$177.83	$204.17	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $85.11 / $269.15	Professional		$58.88	$85.11	$269.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $21.88 / $69.18	Professional	26	$16.22	$21.88	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $63.10 / $199.53	Professional	TC	$42.66	$63.10	$199.53