Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $97.72 / $120.23	Facility	26	$57.54	$97.72	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $67.61 / $165.96	Professional		$54.95	$67.61	$165.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $53.70 / $208.93	Professional	26	$38.02	$53.70	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $21.88 / $44.67	Professional	TC	$17.38	$21.88	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $141.25 / $190.55	Professional		$93.33	$141.25	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $97.72 / $134.90	Professional	26	$64.57	$97.72	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $42.66 / $57.54	Professional	TC	$27.54	$42.66	$57.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $151.36 / $177.83	Professional		$69.18	$151.36	$177.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $104.71 / $123.03	Professional	26	$47.86	$104.71	$123.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $44.67 / $53.70	Professional	TC	$21.38	$44.67	$53.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $120.23 / $208.93	Professional		$63.10	$120.23	$208.93
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $93.33 / $147.91	Professional	26	$48.98	$93.33	$147.91
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $38.90 / $61.66	Professional	TC	$22.91	$38.90	$61.66
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $85.11 / $91.20	Facility	26	$72.44	$85.11	$91.20
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $72.44 / $91.20	Professional	26	$54.95	$72.44	$91.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $30.90 / $38.90	Professional	TC	$23.44	$30.90	$38.90
Providence Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $131.83 / $186.21	Professional		$97.72	$131.83	$186.21
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $87.10 / $128.82	Professional	26	$64.57	$87.10	$128.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $38.02 / $56.23	Professional	TC	$27.54	$38.02	$56.23
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $426.58 / $426.58 / $426.58	Facility	26	$426.58	$426.58	$426.58
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $134.90 / $173.78	Professional		$114.82	$134.90	$173.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $95.50 / $123.03	Professional	26	$81.28	$95.50	$123.03
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $38.90 / $50.12	Professional	TC	$33.88	$38.90	$50.12
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $83.18 / $186.21	Professional		$77.62	$83.18	$186.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $58.88 / $131.83	Professional	26	$52.48	$58.88	$131.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $23.99 / $53.70	Professional	TC	$22.91	$23.99	$53.70