Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.64 / $58.11 / $366.68	Facility	26	$31.64	$58.11	$366.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.28 / $70.33 / $203.41	Professional		$28.28	$70.33	$203.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.80 / $43.36 / $134.36	Professional	26	$17.80	$43.36	$134.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $9.18 / $20.77 / $89.34	Professional	TC	$9.18	$20.77	$89.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.19 / $108.38 / $174.84	Professional		$41.19	$108.38	$174.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.22 / $51.64 / $89.15	Professional	26	$26.22	$51.64	$89.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.50 / $59.65 / $92.00	Professional	TC	$14.50	$59.65	$92.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.20 / $143.58 / $171.82	Professional		$123.20	$143.58	$171.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.64 / $72.88 / $84.17	Professional	26	$61.64	$72.88	$84.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $60.67 / $70.97 / $87.65	Professional	TC	$60.67	$70.97	$87.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $57.12 / $108.46 / $204.77	Professional		$57.12	$108.46	$204.77
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.24 / $58.96 / $103.98	Professional	26	$52.24	$58.96	$103.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.10 / $57.16 / $100.79	Professional	TC	$46.10	$57.16	$100.79
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.92 / $53.35 / $64.98	Facility	26	$33.92	$53.35	$64.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.14 / $42.00 / $58.48	Professional	26	$28.14	$42.00	$58.48
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $13.80 / $21.44 / $62.31	Professional	TC	$13.80	$21.44	$62.31
Providence Facility/Professional Professional Modifier Low / Median / High Price $71.16 / $111.89 / $161.03	Professional		$71.16	$111.89	$161.03
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.03 / $53.99 / $85.65	Professional	26	$29.03	$53.99	$85.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.82 / $63.67 / $92.00	Professional	TC	$20.82	$63.67	$92.00
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 $75.41 / $118.99 / $159.52	Professional		$75.41	$118.99	$159.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.68 / $64.95 / $92.86	Professional	26	$44.68	$64.95	$92.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $17.64 / $59.41 / $88.23	Professional	TC	$17.64	$59.41	$88.23
United Facility/Professional Professional Modifier Low / Median / High Price $36.65 / $69.72 / $163.72	Professional		$36.65	$69.72	$163.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.90 / $28.32 / $102.80	Professional	26	$24.90	$28.32	$102.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.50 / $33.20 / $79.53	Professional	TC	$11.50	$33.20	$79.53