Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $51.29 / $60.26	Facility	26	$33.11	$51.29	$60.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $83.18 / $275.42	Professional		$40.74	$83.18	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $44.67 / $134.90	Professional	26	$20.89	$44.67	$134.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $23.99 / $63.10	Professional	TC	$16.98	$23.99	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $87.10 / $125.89	Professional		$50.12	$87.10	$125.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $44.67 / $69.18	Professional	26	$25.12	$44.67	$69.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $43.65 / $63.10	Professional	TC	$23.44	$43.65	$63.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $93.33 / $117.49	Professional		$75.86	$93.33	$117.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $50.12 / $60.26	Professional	26	$38.90	$50.12	$60.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $44.67 / $56.23	Professional	TC	$36.31	$44.67	$56.23
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $46.77 / $47.86 / $50.12	Facility	26	$46.77	$47.86	$50.12
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $89.13 / $141.25	Professional		$53.70	$89.13	$141.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $48.98 / $75.86	Professional	26	$27.54	$48.98	$75.86
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $44.67 / $67.61	Professional	TC	$24.55	$44.67	$67.61
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $46.77 / $50.12	Facility	26	$38.90	$46.77	$50.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $40.74 / $50.12	Professional	26	$28.84	$40.74	$50.12
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $37.15 / $45.71	Professional	TC	$25.70	$37.15	$45.71
Providence Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $93.33 / $125.89	Professional		$72.44	$93.33	$125.89
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $48.98 / $66.07	Professional	26	$32.36	$48.98	$66.07
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $43.65 / $60.26	Professional	TC	$29.51	$43.65	$60.26
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $95.50 / $125.89	Professional		$79.43	$95.50	$125.89
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $50.12 / $67.61	Professional	26	$43.65	$50.12	$67.61
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $45.71 / $58.88	Professional	TC	$38.02	$45.71	$58.88
United Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $53.70 / $123.03	Professional		$45.71	$53.70	$123.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $27.54 / $66.07	Professional	26	$24.55	$27.54	$66.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $25.70 / $61.66	Professional	TC	$21.88	$25.70	$61.66