Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.16 / $93.16 / $101.41	Facility	26	$93.16	$93.16	$101.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $71.40 / $98.74 / $209.77	Professional		$71.40	$98.74	$209.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.63 / $52.74 / $195.00	Professional	26	$42.63	$52.74	$195.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.17 / $39.61 / $79.00	Professional	TC	$26.17	$39.61	$79.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.53 / $160.88 / $245.84	Professional		$78.53	$160.88	$245.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.35 / $83.19 / $125.52	Professional	26	$51.35	$83.19	$125.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.33 / $68.34 / $126.86	Professional	TC	$26.33	$68.34	$126.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $150.88 / $184.18 / $220.97	Professional		$150.88	$184.18	$220.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $74.06 / $87.19 / $104.60	Professional	26	$74.06	$87.19	$104.60
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $76.81 / $94.17 / $116.36	Professional	TC	$76.81	$94.17	$116.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $99.96 / $129.12 / $215.73	Professional		$99.96	$129.12	$215.73
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.84 / $72.41 / $125.04	Professional	26	$52.84	$72.41	$125.04
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $55.03 / $73.37 / $133.16	Professional	TC	$55.03	$73.37	$133.16
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $62.23 / $80.04 / $85.76	Facility	26	$62.23	$80.04	$85.76
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $49.85 / $72.90 / $91.12	Professional	26	$49.85	$72.90	$91.12
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $31.02 / $42.34 / $86.43	Professional	TC	$31.02	$42.34	$86.43
Providence Facility/Professional Professional Modifier Low / Median / High Price $103.38 / $165.10 / $226.06	Professional		$103.38	$165.10	$226.06
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.35 / $81.51 / $113.19	Professional	26	$51.35	$81.51	$113.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $26.33 / $60.70 / $118.89	Professional	TC	$26.33	$60.70	$118.89
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 $101.09 / $169.29 / $228.63	Professional		$101.09	$169.29	$228.63
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.35 / $85.57 / $112.20	Professional	26	$49.35	$85.57	$112.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $50.62 / $87.31 / $115.28	Professional	TC	$50.62	$87.31	$115.28
United Facility/Professional Professional Modifier Low / Median / High Price $105.59 / $145.05 / $222.41	Professional		$105.59	$145.05	$222.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.97 / $88.41 / $124.93	Professional	26	$60.97	$88.41	$124.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.13 / $62.69 / $125.62	Professional	TC	$37.13	$62.69	$125.62