Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.71 / $114.52 / $233.34	Facility	26	$96.71	$114.52	$233.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.57 / $66.29 / $176.32	Professional		$55.57	$66.29	$176.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.99 / $45.63 / $163.72	Professional	26	$37.99	$45.63	$163.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $21.53 / $48.25	Professional	TC	$17.57	$21.53	$48.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.18 / $140.87 / $179.59	Professional		$94.18	$140.87	$179.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.39 / $97.70 / $125.39	Professional	26	$65.39	$97.70	$125.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.13 / $42.36 / $54.32	Professional	TC	$29.13	$42.36	$54.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $128.58 / $152.66 / $174.16	Professional		$128.58	$152.66	$174.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $89.17 / $106.98 / $120.78	Professional	26	$89.17	$106.98	$120.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.40 / $45.48 / $53.38	Professional	TC	$39.40	$45.48	$53.38
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $97.01 / $115.33 / $196.20	Professional		$97.01	$115.33	$196.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.18 / $92.82 / $138.27	Professional	26	$74.18	$92.82	$138.27
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.95 / $42.77 / $57.96	Professional	TC	$30.95	$42.77	$57.96
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $62.23 / $85.76 / $91.79	Facility	26	$62.23	$85.76	$91.79
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $28.65 / $28.65 / $28.65	Professional		$28.65	$28.65	$28.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $72.90 / $95.36	Professional	26	$52.48	$72.90	$95.36
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.11 / $30.84 / $40.22	Professional	TC	$22.11	$30.84	$40.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $101.91 / $142.75 / $189.15	Professional		$101.91	$142.75	$189.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $60.70 / $87.89 / $125.22	Professional	26	$60.70	$87.89	$125.22
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $24.92 / $39.40 / $54.32	Professional	TC	$24.92	$39.40	$54.32
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $422.45 / $422.45 / $422.45	Facility	26	$422.45	$422.45	$422.45
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $115.51 / $151.41 / $182.87	Professional		$115.51	$151.41	$182.87
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $81.40 / $106.38 / $128.86	Professional	26	$81.40	$106.38	$128.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $34.29 / $44.15 / $54.01	Professional	TC	$34.29	$44.15	$54.01
United Facility/Professional Professional Modifier Low / Median / High Price $79.70 / $83.00 / $205.33	Professional		$79.70	$83.00	$205.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.43 / $59.10 / $144.71	Professional	26	$56.43	$59.10	$144.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.80 / $25.14 / $60.62	Professional	TC	$23.80	$25.14	$60.62