Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.89 / $68.16 / $163.05	Facility	26	$53.89	$68.16	$163.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.69 / $93.64 / $188.45	Professional		$70.69	$93.64	$188.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.77 / $36.00 / $85.08	Professional	26	$29.77	$36.00	$85.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.36 / $58.82 / $119.67	Professional	TC	$40.36	$58.82	$119.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $103.89 / $177.10 / $263.70	Professional		$103.89	$177.10	$263.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.10 / $68.70 / $99.27	Professional	26	$39.10	$68.70	$99.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.19 / $107.38 / $155.83	Professional	TC	$62.19	$107.38	$155.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $143.02 / $166.67 / $201.34	Professional		$143.02	$166.67	$201.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.54 / $72.08 / $84.04	Professional	26	$61.54	$72.08	$84.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.16 / $94.98 / $117.30	Professional	TC	$81.16	$94.98	$117.30
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $119.01 / $155.68 / $227.73	Professional		$119.01	$155.68	$227.73
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.23 / $62.72 / $101.84	Professional	26	$51.23	$62.72	$101.84
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $67.78 / $90.25 / $134.74	Professional	TC	$67.78	$90.25	$134.74
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $49.00 / $63.24 / $68.34	Facility	26	$49.00	$63.24	$68.34
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $41.41 / $58.00 / $71.25	Professional	26	$41.41	$58.00	$71.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $67.54 / $92.22 / $119.99	Professional	TC	$67.54	$92.22	$119.99
Providence Facility/Professional Professional Modifier Low / Median / High Price $137.76 / $178.86 / $230.15	Professional		$137.76	$178.86	$230.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $42.58 / $70.23 / $99.14	Professional	26	$42.58	$70.23	$99.14
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $67.05 / $108.01 / $155.83	Professional	TC	$67.05	$108.01	$155.83
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $140.26 / $180.41 / $240.30	Professional		$140.26	$180.41	$240.30
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.75 / $75.45 / $92.10	Professional	26	$57.75	$75.45	$92.10
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $81.27 / $106.67 / $138.84	Professional	TC	$81.27	$106.67	$138.84
United Facility/Professional Professional Modifier Low / Median / High Price $96.31 / $101.41 / $248.65	Professional		$96.31	$101.41	$248.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.25 / $39.78 / $101.06	Professional	26	$36.25	$39.78	$101.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.15 / $64.59 / $149.28	Professional	TC	$60.15	$64.59	$149.28