Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.31 / $51.82 / $119.15	Facility	26	$46.31	$51.82	$119.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.75 / $72.30 / $262.70	Professional		$41.75	$72.30	$262.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.37 / $33.08 / $131.15	Professional	26	$21.37	$33.08	$131.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.39 / $23.98 / $60.62	Professional	TC	$20.39	$23.98	$60.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.78 / $95.28 / $133.16	Professional		$52.78	$95.28	$133.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.60 / $49.54 / $70.95	Professional	26	$27.60	$49.54	$70.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.18 / $48.01 / $65.84	Professional	TC	$25.18	$48.01	$65.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $84.60 / $98.59 / $117.79	Professional		$84.60	$98.59	$117.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.45 / $52.55 / $60.70	Professional	26	$44.45	$52.55	$60.70
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.51 / $46.23 / $57.09	Professional	TC	$39.51	$46.23	$57.09
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $64.05 / $76.86 / $140.06	Professional		$64.05	$76.86	$140.06
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.09 / $44.89 / $74.26	Professional	26	$35.09	$44.89	$74.26
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.08 / $45.77 / $74.26	Professional	TC	$33.08	$45.77	$74.26
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.85 / $46.48 / $48.96	Facility	26	$35.85	$46.48	$48.96
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $22.39 / $22.39	Professional		$22.39	$22.39	$22.39
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $29.60 / $40.63 / $50.32	Professional	26	$29.60	$40.63	$50.32
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.13 / $34.60 / $45.12	Professional	TC	$26.13	$34.60	$45.12
Providence Facility/Professional Professional Modifier Low / Median / High Price $77.78 / $97.20 / $130.22	Professional		$77.78	$97.20	$130.22
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.86 / $51.30 / $70.08	Professional	26	$31.86	$51.30	$70.08
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.74 / $47.11 / $62.21	Professional	TC	$28.74	$47.11	$62.21
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 $80.20 / $107.45 / $126.96	Professional		$80.20	$107.45	$126.96
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.49 / $56.64 / $67.48	Professional	26	$43.49	$56.64	$67.48
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $38.29 / $51.37 / $60.64	Professional	TC	$38.29	$51.37	$60.64
United Facility/Professional Professional Modifier Low / Median / High Price $47.64 / $53.53 / $136.44	Professional		$47.64	$53.53	$136.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.62 / $26.56 / $73.38	Professional	26	$25.62	$26.56	$73.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.92 / $29.93 / $68.09	Professional	TC	$21.92	$29.93	$68.09