Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.94 / $47.94 / $52.91	Facility	26	$47.94	$47.94	$52.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.69 / $75.00 / $152.47	Professional		$29.69	$75.00	$152.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.17 / $33.29 / $52.45	Professional	26	$15.17	$33.29	$52.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $11.89 / $32.97 / $97.42	Professional	TC	$11.89	$32.97	$97.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.05 / $24.05 / $24.05	Facility	26	$24.05	$24.05	$24.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.00 / $84.65 / $136.68	Professional		$51.00	$84.65	$136.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.41 / $43.17 / $64.81	Professional	26	$29.41	$43.17	$64.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.17 / $38.28 / $87.44	Professional	TC	$23.17	$38.28	$87.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $76.56 / $90.34 / $103.72	Professional		$76.56	$90.34	$103.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.60 / $48.63 / $54.99	Professional	26	$40.60	$48.63	$54.99
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.78 / $41.53 / $48.76	Professional	TC	$34.78	$41.53	$48.76
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $61.91 / $81.59 / $215.16	Professional		$61.91	$81.59	$215.16
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.63 / $47.89 / $66.84	Professional	26	$33.63	$47.89	$66.84
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.28 / $40.28 / $126.63	Professional	TC	$28.28	$40.28	$126.63
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $30.87 / $41.76 / $58.71	Facility	26	$30.87	$41.76	$58.71
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $25.33 / $40.95 / $55.80	Professional	26	$25.33	$40.95	$55.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $20.05 / $29.70 / $130.41	Professional	TC	$20.05	$29.70	$130.41
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $24.05 / $24.05 / $24.05	Facility	26	$24.05	$24.05	$24.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $67.02 / $86.77 / $115.39	Professional		$67.02	$86.77	$115.39
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.54 / $44.83 / $61.95	Professional	26	$28.54	$44.83	$61.95
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $24.06 / $37.85 / $64.47	Professional	TC	$24.06	$37.85	$64.47
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $354.01 / $354.01 / $354.01	Facility	26	$354.01	$354.01	$354.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $66.77 / $85.70 / $109.91	Professional		$66.77	$85.70	$109.91
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $38.24 / $46.15 / $60.42	Professional	26	$38.24	$46.15	$60.42
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $28.52 / $38.24 / $50.22	Professional	TC	$28.52	$38.24	$50.22
United Facility/Professional Professional Modifier Low / Median / High Price $39.70 / $74.80 / $128.35	Professional		$39.70	$74.80	$128.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.74 / $41.71 / $65.27	Professional	26	$22.74	$41.71	$65.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.96 / $31.50 / $58.83	Professional	TC	$16.96	$31.50	$58.83