Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.10 / $50.40 / $116.62	Facility	26	$32.10	$50.40	$116.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.00 / $88.24 / $340.90	Professional		$52.00	$88.24	$340.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.92 / $32.11 / $95.56	Professional	26	$16.92	$32.11	$95.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.93 / $63.43 / $104.65	Professional	TC	$24.93	$63.43	$104.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.14 / $108.36 / $171.66	Professional		$62.14	$108.36	$171.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.44 / $47.06 / $68.33	Professional	26	$22.44	$47.06	$68.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.97 / $60.62 / $108.83	Professional	TC	$30.97	$60.62	$108.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.91 / $111.78 / $134.12	Professional		$95.91	$111.78	$134.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.20 / $52.29 / $60.36	Professional	26	$44.20	$52.29	$60.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.04 / $59.72 / $73.76	Professional	TC	$51.04	$59.72	$73.76
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $79.65 / $114.02 / $159.15	Professional		$79.65	$114.02	$159.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.97 / $44.62 / $74.26	Professional	26	$34.97	$44.62	$74.26
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.70 / $56.42 / $84.89	Professional	TC	$42.70	$56.42	$84.89
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.14 / $45.07 / $46.92	Facility	26	$33.14	$45.07	$46.92
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $35.00 / $35.67 / $60.54	Professional		$35.00	$35.67	$60.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $26.10 / $36.18 / $52.54	Professional	26	$26.10	$36.18	$52.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.00 / $48.41 / $122.43	Professional	TC	$33.00	$48.41	$122.43
Providence Facility/Professional Professional Modifier Low / Median / High Price $83.57 / $110.10 / $150.38	Professional		$83.57	$110.10	$150.38
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $48.83 / $68.33	Professional	26	$26.92	$48.83	$68.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $33.07 / $60.12 / $108.83	Professional	TC	$33.07	$60.12	$108.83
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 $87.38 / $116.31 / $138.34	Professional		$87.38	$116.31	$138.34
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $41.90 / $55.39 / $66.33	Professional	26	$41.90	$55.39	$66.33
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $45.49 / $61.62 / $72.01	Professional	TC	$45.49	$61.62	$72.01
United Facility/Professional Professional Modifier Low / Median / High Price $47.79 / $59.90 / $153.90	Professional		$47.79	$59.90	$153.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.28 / $25.96 / $77.70	Professional	26	$21.28	$25.96	$77.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.00 / $38.61 / $83.30	Professional	TC	$23.00	$38.61	$83.30