Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.07 / $19.07 / $19.07	Facility	26	$19.07	$19.07	$19.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $68.06 / $83.08 / $300.80	Professional		$68.06	$83.08	$300.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.82 / $22.33 / $74.00	Professional	26	$17.82	$22.33	$74.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.22 / $58.34 / $103.58	Professional	TC	$50.22	$58.34	$103.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.55 / $67.55 / $67.55	Professional		$67.55	$67.55	$67.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.45 / $18.45 / $18.45	Professional	26	$18.45	$18.45	$18.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.10 / $49.10 / $49.10	Professional	TC	$49.10	$49.10	$49.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $152.29 / $177.96 / $206.27	Professional		$152.29	$177.96	$206.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.71 / $47.69 / $53.79	Professional	26	$39.71	$47.69	$53.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $112.57 / $129.87 / $152.47	Professional	TC	$112.57	$129.87	$152.47
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $120.40 / $167.31 / $240.85	Professional		$120.40	$167.31	$240.85
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.08 / $47.12 / $65.76	Professional	26	$33.08	$47.12	$65.76
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $88.06 / $125.42 / $175.05	Professional	TC	$88.06	$125.42	$175.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $27.93 / $38.86 / $40.86	Facility	26	$27.93	$38.86	$40.86
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $26.45 / $33.54 / $40.86	Professional	26	$26.45	$33.54	$40.86
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $71.59 / $100.08 / $110.55	Professional	TC	$71.59	$100.08	$110.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $67.55 / $158.97 / $219.22	Professional		$67.55	$158.97	$219.22
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $18.45 / $18.45 / $26.73	Professional	26	$18.45	$18.45	$26.73
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $49.10 / $49.10 / $71.56	Professional	TC	$49.10	$49.10	$71.56
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $127.11 / $178.11 / $211.29	Professional		$127.11	$178.11	$211.29
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $34.77 / $48.07 / $57.80	Professional	26	$34.77	$48.07	$57.80
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $92.34 / $130.04 / $153.50	Professional	TC	$92.34	$130.04	$153.50
United Facility/Professional Professional Modifier Low / Median / High Price $94.33 / $96.45 / $231.03	Professional		$94.33	$96.45	$231.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.08 / $32.95 / $64.89	Professional	26	$25.08	$32.95	$64.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $68.73 / $127.59 / $167.84	Professional	TC	$68.73	$127.59	$167.84