Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.81 / $54.35 / $120.98	Facility	26	$47.81	$54.35	$120.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.82 / $78.34 / $163.24	Professional		$41.82	$78.34	$163.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.48 / $30.23 / $95.06	Professional	26	$23.48	$30.23	$95.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.95 / $53.40 / $102.95	Professional	TC	$23.95	$53.40	$102.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.53 / $103.02 / $156.69	Professional		$81.53	$103.02	$156.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.17 / $50.63 / $69.81	Professional	26	$36.17	$50.63	$69.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.27 / $54.20 / $80.97	Professional	TC	$34.27	$54.20	$80.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $80.83 / $95.58 / $109.48	Professional		$80.83	$95.58	$109.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.21 / $55.44 / $62.60	Professional	26	$46.21	$55.44	$62.60
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.61 / $39.94 / $46.89	Professional	TC	$34.61	$39.94	$46.89
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $69.63 / $93.51 / $141.05	Professional		$69.63	$93.51	$141.05
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.76 / $48.10 / $72.18	Professional	26	$40.76	$48.10	$72.18
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.88 / $40.76 / $87.57	Professional	TC	$28.88	$40.76	$87.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.51 / $45.98 / $49.13	Facility	26	$35.51	$45.98	$49.13
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $38.92 / $38.92 / $68.81	Professional		$38.92	$38.92	$68.81
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $27.33 / $43.07 / $52.93	Professional	26	$27.33	$43.07	$52.93
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.34 / $70.84 / $97.82	Professional	TC	$25.34	$70.84	$97.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $75.27 / $98.36 / $151.04	Professional		$75.27	$98.36	$151.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.71 / $46.38 / $66.09	Professional	26	$31.71	$46.38	$66.09
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.48 / $47.72 / $80.97	Professional	TC	$19.48	$47.72	$80.97
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $422.45 / $422.45 / $422.45	Facility	26	$422.45	$422.45	$422.45
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $71.81 / $100.32 / $128.63	Professional		$71.81	$100.32	$128.63
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.73 / $55.33 / $67.27	Professional	26	$44.73	$55.33	$67.27
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $27.20 / $38.56 / $63.62	Professional	TC	$27.20	$38.56	$63.62
United Facility/Professional Professional Modifier Low / Median / High Price $60.45 / $100.75 / $126.54	Professional		$60.45	$100.75	$126.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.68 / $35.79 / $78.81	Professional	26	$30.68	$35.79	$78.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.77 / $45.74 / $70.45	Professional	TC	$29.77	$45.74	$70.45