Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $99.29 / $99.29 / $108.99	Facility	26	$99.29	$99.29	$108.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.78 / $84.97 / $142.41	Professional		$76.78	$84.97	$142.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.24 / $46.00 / $81.68	Professional	26	$41.24	$46.00	$81.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.35 / $41.90 / $78.93	Professional	TC	$37.35	$41.90	$78.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $50.00 / $50.00	Facility	26	$50.00	$50.00	$50.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $101.85 / $175.08 / $243.84	Professional		$101.85	$175.08	$243.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.64 / $91.05 / $124.56	Professional	26	$57.64	$91.05	$124.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.39 / $88.90 / $123.46	Professional	TC	$45.39	$88.90	$123.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.76 / $201.79 / $231.72	Professional		$154.76	$201.79	$231.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.68 / $99.98 / $112.57	Professional	26	$76.68	$99.98	$112.57
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $78.08 / $101.48 / $119.14	Professional	TC	$78.08	$101.48	$119.14
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $110.36 / $151.28 / $258.36	Professional		$110.36	$151.28	$258.36
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.38 / $78.72 / $137.91	Professional	26	$69.38	$78.72	$137.91
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.86 / $75.11 / $136.87	Professional	TC	$32.86	$75.11	$136.87
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $86.04 / $87.10	Facility	26	$62.50	$86.04	$87.10
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $58.82 / $76.45 / $89.38	Professional	26	$58.82	$76.45	$89.38
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $47.84 / $67.59 / $89.11	Professional	TC	$47.84	$67.59	$89.11
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $50.00 / $50.00	Facility	26	$50.00	$50.00	$50.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $112.10 / $184.34 / $240.12	Professional		$112.10	$184.34	$240.12
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.30 / $91.05 / $124.56	Professional	26	$58.30	$91.05	$124.56
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $45.39 / $89.76 / $124.97	Professional	TC	$45.39	$89.76	$124.97
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $459.43 / $459.43 / $459.43	Facility	26	$459.43	$459.43	$459.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $140.94 / $173.96 / $247.30	Professional		$140.94	$173.96	$247.30
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $70.73 / $87.31 / $124.12	Professional	26	$70.73	$87.31	$124.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $66.69 / $86.65 / $123.18	Professional	TC	$66.69	$86.65	$123.18
United Facility/Professional Professional Modifier Low / Median / High Price $126.36 / $175.71 / $270.41	Professional		$126.36	$175.71	$270.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.35 / $93.27 / $138.07	Professional	26	$59.35	$93.27	$138.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.27 / $80.97 / $130.94	Professional	TC	$59.27	$80.97	$130.94