Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.28 / $54.34 / $118.75	Facility	26	$38.28	$54.34	$118.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.03 / $112.65 / $348.88	Professional		$58.03	$112.65	$348.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.26 / $32.35 / $108.63	Professional	26	$25.26	$32.35	$108.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.07 / $78.09 / $128.65	Professional	TC	$31.07	$78.09	$128.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.84 / $131.54 / $207.69	Professional		$74.84	$131.54	$207.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.02 / $57.05 / $79.70	Professional	26	$32.02	$57.05	$79.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.40 / $75.04 / $126.68	Professional	TC	$37.40	$75.04	$126.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $116.29 / $135.52 / $162.81	Professional		$116.29	$135.52	$162.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.64 / $61.07 / $70.51	Professional	26	$51.64	$61.07	$70.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $63.86 / $74.70 / $92.27	Professional	TC	$63.86	$74.70	$92.27
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $94.35 / $134.00 / $193.09	Professional		$94.35	$134.00	$193.09
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.76 / $54.37 / $86.99	Professional	26	$43.76	$54.37	$86.99
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $53.38 / $68.03 / $106.11	Professional	TC	$53.38	$68.03	$106.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $42.14 / $54.03 / $55.02	Facility	26	$42.14	$54.03	$55.02
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $56.58 / $56.90 / $61.76	Professional		$56.58	$56.90	$61.76
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.96 / $49.20 / $61.50	Professional	26	$32.96	$49.20	$61.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $35.22 / $59.22 / $142.71	Professional	TC	$35.22	$59.22	$142.71
Providence Facility/Professional Professional Modifier Low / Median / High Price $100.65 / $132.75 / $179.95	Professional		$100.65	$132.75	$179.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.57 / $59.74 / $79.65	Professional	26	$36.57	$59.74	$79.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $41.22 / $75.04 / $135.13	Professional	TC	$41.22	$75.04	$135.13
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $105.93 / $140.93 / $167.71	Professional		$105.93	$140.93	$167.71
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.43 / $65.81 / $77.77	Professional	26	$50.43	$65.81	$77.77
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $56.86 / $76.34 / $90.01	Professional	TC	$56.86	$76.34	$90.01
United Facility/Professional Professional Modifier Low / Median / High Price $58.21 / $77.88 / $188.31	Professional		$58.21	$77.88	$188.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.11 / $31.98 / $84.96	Professional	26	$29.11	$31.98	$84.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.36 / $39.40 / $100.12	Professional	TC	$29.36	$39.40	$100.12