Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.68 / $81.68 / $88.74	Facility	26	$81.68	$81.68	$88.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.95 / $82.54 / $179.67	Professional		$66.95	$82.54	$179.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.58 / $49.50 / $91.18	Professional	26	$38.58	$49.50	$91.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.57 / $37.85 / $66.39	Professional	TC	$22.57	$37.85	$66.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $68.54 / $138.87 / $211.43	Professional		$68.54	$138.87	$211.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.62 / $72.44 / $113.71	Professional	26	$45.62	$72.44	$113.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.16 / $57.62 / $107.19	Professional	TC	$22.16	$57.62	$107.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $129.40 / $157.80 / $189.32	Professional		$129.40	$157.80	$189.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.81 / $76.23 / $91.47	Professional	26	$64.81	$76.23	$91.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $64.59 / $79.18 / $97.83	Professional	TC	$64.59	$79.18	$97.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $89.32 / $113.14 / $185.14	Professional		$89.32	$113.14	$185.14
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.29 / $63.44 / $109.80	Professional	26	$46.29	$63.44	$109.80
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.29 / $63.44 / $111.84	Professional	TC	$46.29	$63.44	$111.84
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $58.26 / $70.04 / $86.43	Facility	26	$58.26	$70.04	$86.43
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $52.26 / $73.53 / $90.99	Professional	26	$52.26	$73.53	$90.99
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $23.72 / $35.84 / $61.20	Professional	TC	$23.72	$35.84	$61.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $91.37 / $143.12 / $194.02	Professional		$91.37	$143.12	$194.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.62 / $71.05 / $102.38	Professional	26	$45.62	$71.05	$102.38
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $22.16 / $51.19 / $100.40	Professional	TC	$22.16	$51.19	$100.40
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 $86.76 / $145.77 / $195.83	Professional		$86.76	$145.77	$195.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $42.98 / $75.00 / $101.41	Professional	26	$42.98	$75.00	$101.41
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.50 / $73.31 / $97.19	Professional	TC	$42.50	$73.31	$97.19
United Facility/Professional Professional Modifier Low / Median / High Price $93.76 / $133.91 / $193.29	Professional		$93.76	$133.91	$193.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.58 / $81.65 / $111.62	Professional	26	$54.58	$81.65	$111.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.36 / $51.99 / $94.97	Professional	TC	$31.36	$51.99	$94.97