Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.01 / $70.01 / $76.34	Facility	26	$70.01	$70.01	$76.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.82 / $73.94 / $120.33	Professional		$51.82	$73.94	$120.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.82 / $36.13 / $62.83	Professional	26	$31.82	$36.13	$62.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.32 / $32.45 / $67.03	Professional	TC	$19.32	$32.45	$67.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.99 / $124.34 / $197.66	Professional		$59.99	$124.34	$197.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.72 / $62.75 / $94.66	Professional	26	$37.72	$62.75	$94.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.16 / $57.62 / $108.17	Professional	TC	$21.16	$57.62	$108.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $121.58 / $148.66 / $178.36	Professional		$121.58	$148.66	$178.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.37 / $66.34 / $79.59	Professional	26	$56.37	$66.34	$79.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $65.20 / $79.93 / $98.76	Professional	TC	$65.20	$79.93	$98.76
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $74.45 / $106.21 / $173.80	Professional		$74.45	$106.21	$173.80
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.18 / $55.06 / $93.54	Professional	26	$40.18	$55.06	$93.54
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.03 / $62.30 / $112.83	Professional	TC	$46.03	$62.30	$112.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $44.59 / $60.93 / $62.56	Facility	26	$44.59	$60.93	$62.56
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $41.40 / $52.44 / $69.00	Professional	26	$41.40	$52.44	$69.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.80 / $30.72 / $54.06	Professional	TC	$22.80	$30.72	$54.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $80.50 / $131.94 / $180.40	Professional		$80.50	$131.94	$180.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.09 / $60.98 / $84.37	Professional	26	$38.09	$60.98	$84.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $21.16 / $51.19 / $101.32	Professional	TC	$21.16	$51.19	$101.32
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $127.19 / $127.19 / $127.19	Facility	26	$127.19	$127.19	$127.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $80.79 / $135.30 / $180.84	Professional		$80.79	$135.30	$180.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.21 / $64.36 / $84.61	Professional	26	$37.21	$64.36	$84.61
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.88 / $73.98 / $98.08	Professional	TC	$42.88	$73.98	$98.08
United Facility/Professional Professional Modifier Low / Median / High Price $77.01 / $115.23 / $177.76	Professional		$77.01	$115.23	$177.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.16 / $65.29 / $94.29	Professional	26	$44.16	$65.29	$94.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.79 / $53.59 / $95.84	Professional	TC	$31.79	$53.59	$95.84