Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $83.18 / $89.13	Facility	26	$47.86	$83.18	$89.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $79.43 / $199.53	Professional		$64.57	$79.43	$199.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $45.71 / $95.50	Professional	26	$33.88	$45.71	$95.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $36.31 / $67.61	Professional	TC	$20.89	$36.31	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $134.90 / $213.80	Professional		$66.07	$134.90	$213.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $67.61 / $114.82	Professional	26	$43.65	$67.61	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $64.57 / $107.15	Professional	TC	$21.88	$64.57	$107.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $151.36 / $190.55	Professional		$125.89	$151.36	$190.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $75.86 / $91.20	Professional	26	$60.26	$75.86	$91.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $77.62 / $97.72	Professional	TC	$64.57	$77.62	$97.72
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $117.49 / $177.83	Professional		$83.18	$117.49	$177.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $69.18 / $93.33	Professional	26	$44.67	$69.18	$93.33
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $66.07 / $95.50	Professional	TC	$42.66	$66.07	$95.50
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $70.79 / $87.10	Facility	26	$58.88	$70.79	$87.10
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $72.44 / $91.20	Professional	26	$51.29	$72.44	$91.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $35.48 / $61.66	Professional	TC	$25.12	$35.48	$61.66
Providence Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $141.25 / $194.98	Professional		$85.11	$141.25	$194.98
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $70.79 / $100.00	Professional	26	$45.71	$70.79	$100.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $47.86 / $95.50	Professional	TC	$25.12	$47.86	$95.50
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 $91.20 / $144.54 / $190.55	Professional		$91.20	$144.54	$190.55
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $74.13 / $95.50	Professional	26	$45.71	$74.13	$95.50
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $74.13 / $97.72	Professional	TC	$39.81	$74.13	$97.72
United Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $131.83 / $186.21	Professional		$85.11	$131.83	$186.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $79.43 / $107.15	Professional	26	$47.86	$79.43	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $53.70 / $91.20	Professional	TC	$30.90	$53.70	$91.20