Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $95.50 / $102.33	Facility	26	$54.95	$95.50	$102.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $93.33 / $204.17	Professional		$70.79	$93.33	$204.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $50.12 / $190.55	Professional	26	$38.02	$50.12	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $42.66 / $81.28	Professional	TC	$25.70	$42.66	$81.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $158.49 / $245.47	Professional		$77.62	$158.49	$245.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $77.62 / $120.23	Professional	26	$48.98	$77.62	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $77.62 / $125.89	Professional	TC	$25.70	$77.62	$125.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $177.83 / $218.78	Professional		$147.91	$177.83	$218.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $87.10 / $104.71	Professional	26	$69.18	$87.10	$104.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $91.20 / $117.49	Professional	TC	$77.62	$91.20	$117.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $134.90 / $204.17	Professional		$95.50	$134.90	$204.17
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $77.62 / $104.71	Professional	26	$50.12	$77.62	$104.71
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $77.62 / $112.20	Professional	TC	$50.12	$77.62	$112.20
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $79.43 / $85.11	Facility	26	$66.07	$79.43	$85.11
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $75.86 / $93.33	Professional	26	$51.29	$75.86	$93.33
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $42.66 / $83.18	Professional	TC	$28.18	$42.66	$83.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $165.96 / $223.87	Professional		$95.50	$165.96	$223.87
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $79.43 / $109.65	Professional	26	$52.48	$79.43	$109.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $58.88 / $112.20	Professional	TC	$29.51	$58.88	$112.20
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $125.89 / $125.89	Facility	26	$125.89	$125.89	$125.89
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $169.82 / $223.87	Professional		$107.15	$169.82	$223.87
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $83.18 / $107.15	Professional	26	$51.29	$83.18	$107.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $87.10 / $114.82	Professional	TC	$46.77	$87.10	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $147.91 / $218.78	Professional		$95.50	$147.91	$218.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $87.10 / $120.23	Professional	26	$54.95	$87.10	$120.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $63.10 / $107.15	Professional	TC	$36.31	$63.10	$107.15