Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.93 / $56.93 / $61.97	Facility	26	$56.93	$56.93	$61.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.79 / $66.40 / $186.00	Professional		$43.79	$66.40	$186.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.78 / $31.76 / $108.98	Professional	26	$25.78	$31.76	$108.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.87 / $30.57 / $63.87	Professional	TC	$17.87	$30.57	$63.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.51 / $106.87 / $176.02	Professional		$51.51	$106.87	$176.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.03 / $51.12 / $77.17	Professional	26	$31.03	$51.12	$77.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.04 / $56.09 / $103.25	Professional	TC	$20.04	$56.09	$103.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.41 / $131.66 / $158.06	Professional		$107.41	$131.66	$158.06
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.25 / $53.28 / $63.92	Professional	26	$45.25	$53.28	$63.92
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $62.14 / $76.17 / $94.14	Professional	TC	$62.14	$76.17	$94.14
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $62.06 / $88.16 / $153.71	Professional		$62.06	$88.16	$153.71
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.32 / $44.53 / $76.26	Professional	26	$32.32	$44.53	$76.26
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.88 / $61.36 / $108.21	Professional	TC	$43.88	$61.36	$108.21
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $36.26 / $48.91 / $51.00	Facility	26	$36.26	$48.91	$51.00
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $45.22 / $57.38	Professional	26	$29.75	$45.22	$57.38
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $19.60 / $30.15 / $67.15	Professional	TC	$19.60	$30.15	$67.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $70.69 / $118.30 / $161.88	Professional		$70.69	$118.30	$161.88
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.03 / $49.61 / $68.64	Professional	26	$31.03	$49.61	$68.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.04 / $49.83 / $96.70	Professional	TC	$20.04	$49.83	$96.70
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 $72.44 / $121.30 / $162.10	Professional		$72.44	$121.30	$162.10
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $30.34 / $52.27 / $68.98	Professional	26	$30.34	$52.27	$68.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.34 / $71.31 / $94.16	Professional	TC	$41.34	$71.31	$94.16
United Facility/Professional Professional Modifier Low / Median / High Price $68.75 / $104.72 / $163.93	Professional		$68.75	$104.72	$163.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.00 / $52.51 / $76.81	Professional	26	$36.00	$52.51	$76.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.16 / $51.59 / $92.37	Professional	TC	$28.16	$51.59	$92.37