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 $66.07 / $89.13 / $288.40	Professional		$66.07	$89.13	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $47.86 / $120.23	Professional	26	$38.02	$47.86	$120.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $38.90 / $74.13	Professional	TC	$21.88	$38.90	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $151.36 / $234.42	Professional		$74.13	$151.36	$234.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $77.62 / $120.23	Professional	26	$46.77	$77.62	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $70.79 / $114.82	Professional	TC	$23.44	$70.79	$114.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $169.82 / $208.93	Professional		$138.04	$169.82	$208.93
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 $70.79 / $83.18 / $104.71	Professional	TC	$70.79	$83.18	$104.71
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $128.82 / $194.98	Professional		$87.10	$128.82	$194.98
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $75.86 / $104.71	Professional	26	$47.86	$75.86	$104.71
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $70.79 / $100.00	Professional	TC	$44.67	$70.79	$100.00
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $79.43 / $83.18	Facility	26	$66.07	$79.43	$83.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $69.18 / $85.11	Professional	26	$48.98	$69.18	$85.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $35.48 / $57.54	Professional	TC	$26.30	$35.48	$57.54
Providence Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $154.88 / $213.80	Professional		$91.20	$154.88	$213.80
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $77.62 / $107.15	Professional	26	$51.29	$77.62	$107.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $52.48 / $102.33	Professional	TC	$26.30	$52.48	$102.33
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 $102.33 / $162.18 / $213.80	Professional		$102.33	$162.18	$213.80
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 $42.66 / $79.43 / $104.71	Professional	TC	$42.66	$79.43	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $141.25 / $208.93	Professional		$89.13	$141.25	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $85.11 / $117.49	Professional	26	$53.70	$85.11	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $57.54 / $97.72	Professional	TC	$32.36	$57.54	$97.72