Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $57.54 / $63.10	Facility	26	$33.11	$57.54	$63.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $64.57 / $165.96	Professional		$43.65	$64.57	$165.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $30.20 / $107.15	Professional	26	$22.91	$30.20	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $33.11 / $67.61	Professional	TC	$16.98	$33.11	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $109.65 / $177.83	Professional		$50.12	$109.65	$177.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $46.77 / $74.13	Professional	26	$29.51	$46.77	$74.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $63.10 / $102.33	Professional	TC	$19.95	$63.10	$102.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $125.89 / $158.49	Professional		$104.71	$125.89	$158.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $53.70 / $64.57	Professional	26	$42.66	$53.70	$64.57
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $74.13 / $93.33	Professional	TC	$63.10	$74.13	$93.33
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $89.13 / $147.91	Professional		$61.66	$89.13	$147.91
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $47.86 / $64.57	Professional	26	$30.20	$47.86	$64.57
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $64.57 / $91.20	Professional	TC	$40.74	$64.57	$91.20
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $48.98 / $51.29	Facility	26	$40.74	$48.98	$51.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $44.67 / $56.23	Professional	26	$30.90	$44.67	$56.23
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $30.20 / $67.61	Professional	TC	$20.89	$30.20	$67.61
Providence Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $117.49 / $162.18	Professional		$64.57	$117.49	$162.18
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $47.86 / $66.07	Professional	26	$31.62	$47.86	$66.07
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $45.71 / $93.33	Professional	TC	$20.89	$45.71	$93.33
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 $75.86 / $120.23 / $158.49	Professional		$75.86	$120.23	$158.49
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $51.29 / $66.07	Professional	26	$31.62	$51.29	$66.07
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $70.79 / $93.33	Professional	TC	$37.15	$70.79	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $102.33 / $154.88	Professional		$64.57	$102.33	$154.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $52.48 / $72.44	Professional	26	$32.36	$52.48	$72.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $51.29 / $87.10	Professional	TC	$25.70	$51.29	$87.10