Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.56 / $75.06 / $83.05	Facility	26	$49.56	$75.06	$83.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.28 / $89.00 / $283.89	Professional		$61.28	$89.00	$283.89
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $113.88 / $113.88 / $113.88	Professional	25	$113.88	$113.88	$113.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.86 / $46.18 / $178.63	Professional	26	$35.86	$46.18	$178.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.57 / $42.61 / $89.91	Professional	TC	$22.57	$42.61	$89.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.15 / $145.44 / $231.09	Professional		$70.15	$145.44	$231.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.25 / $74.23 / $112.15	Professional	26	$45.25	$74.23	$112.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.70 / $67.31 / $124.89	Professional	TC	$24.70	$67.31	$124.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.86 / $173.41 / $208.04	Professional		$141.86	$173.41	$208.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $66.26 / $77.95 / $93.52	Professional	26	$66.26	$77.95	$93.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.59 / $92.67 / $114.52	Professional	TC	$75.59	$92.67	$114.52
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $85.68 / $123.82 / $202.61	Professional		$85.68	$123.82	$202.61
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.16 / $64.62 / $110.82	Professional	26	$47.16	$64.62	$110.82
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.15 / $74.20 / $131.13	Professional	TC	$54.15	$74.20	$131.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.41 / $71.61 / $75.48	Facility	26	$53.41	$71.61	$75.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $43.82 / $62.98 / $82.49	Professional	26	$43.82	$62.98	$82.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $23.64 / $35.64 / $75.14	Professional	TC	$23.64	$35.64	$75.14
Providence Facility/Professional Professional Modifier Low / Median / High Price $94.43 / $154.69 / $211.82	Professional		$94.43	$154.69	$211.82
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.27 / $72.79 / $101.09	Professional	26	$45.27	$72.79	$101.09
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $24.70 / $59.80 / $117.04	Professional	TC	$24.70	$59.80	$117.04
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $127.19 / $127.19 / $127.19	Facility	26	$127.19	$127.19	$127.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $94.72 / $158.63 / $214.57	Professional		$94.72	$158.63	$214.57
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.09 / $76.38 / $100.25	Professional	26	$44.09	$76.38	$100.25
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $49.84 / $85.98 / $113.52	Professional	TC	$49.84	$85.98	$113.52
United Facility/Professional Professional Modifier Low / Median / High Price $90.17 / $136.01 / $218.91	Professional		$90.17	$136.01	$218.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.80 / $77.54 / $112.75	Professional	26	$52.80	$77.54	$112.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.28 / $62.30 / $111.38	Professional	TC	$35.28	$62.30	$111.38