Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.98 / $46.98 / $50.97	Facility	26	$46.98	$46.98	$50.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.85 / $48.52 / $90.74	Professional		$29.85	$48.52	$90.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.55 / $22.76 / $50.07	Professional	26	$19.55	$22.76	$50.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.31 / $16.87 / $59.46	Professional	TC	$10.31	$16.87	$59.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.07 / $93.41 / $156.36	Professional		$40.07	$93.41	$156.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.72 / $42.12 / $63.79	Professional	26	$24.72	$42.12	$63.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.90 / $52.52 / $95.52	Professional	TC	$15.90	$52.52	$95.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.11 / $116.59 / $140.19	Professional		$95.11	$116.59	$140.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.24 / $43.80 / $52.55	Professional	26	$37.24	$43.80	$52.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.87 / $70.93 / $87.65	Professional	TC	$57.87	$70.93	$87.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $45.39 / $80.73 / $136.24	Professional		$45.39	$80.73	$136.24
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.64 / $36.50 / $64.70	Professional	26	$26.64	$36.50	$64.70
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.49 / $55.31 / $100.65	Professional	TC	$41.49	$55.31	$100.65
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $30.04 / $40.24 / $41.54	Facility	26	$30.04	$40.24	$41.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $24.80 / $35.96 / $42.00	Professional	26	$24.80	$35.96	$42.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $12.31 / $17.88 / $62.53	Professional	TC	$12.31	$17.88	$62.53
Providence Facility/Professional Professional Modifier Low / Median / High Price $56.76 / $104.69 / $143.29	Professional		$56.76	$104.69	$143.29
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.91 / $40.74 / $56.58	Professional	26	$24.91	$40.74	$56.58
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $16.48 / $46.66 / $90.23	Professional	TC	$16.48	$46.66	$90.23
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $127.19 / $127.19 / $127.19	Facility	26	$127.19	$127.19	$127.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $62.21 / $107.31 / $143.36	Professional		$62.21	$107.31	$143.36
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $25.08 / $42.59 / $57.02	Professional	26	$25.08	$42.59	$57.02
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $38.25 / $65.98 / $87.38	Professional	TC	$38.25	$65.98	$87.38
United Facility/Professional Professional Modifier Low / Median / High Price $53.40 / $88.44 / $139.03	Professional		$53.40	$88.44	$139.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.80 / $42.70 / $61.02	Professional	26	$28.80	$42.70	$61.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.54 / $48.23 / $85.43	Professional	TC	$17.54	$48.23	$85.43