Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $32.36 / $34.67	Facility	26	$19.05	$32.36	$34.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $57.54 / $100.00	Professional		$41.69	$57.54	$100.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $15.85 / $32.36	Professional	26	$12.88	$15.85	$32.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $40.74 / $67.61	Professional	TC	$28.84	$40.74	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $87.10 / $138.04	Professional		$57.54	$87.10	$138.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $26.92 / $41.69	Professional	26	$16.60	$26.92	$41.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $60.26 / $100.00	Professional	TC	$40.74	$60.26	$100.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $87.10 / $112.20	Professional		$70.79	$87.10	$112.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $28.84 / $35.48	Professional	26	$22.91	$28.84	$35.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $58.88 / $75.86	Professional	TC	$48.98	$58.88	$75.86
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $85.11 / $107.15	Professional		$56.23	$85.11	$107.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $25.12 / $36.31	Professional	26	$16.98	$25.12	$36.31
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $52.48 / $77.62	Professional	TC	$34.67	$52.48	$77.62
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $22.39 / $26.92 / $30.20	Facility	26	$22.39	$26.92	$30.20
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $26.30 / $31.62	Professional	26	$19.05	$26.30	$31.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $58.88 / $75.86	Professional	TC	$43.65	$58.88	$75.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $95.50 / $125.89	Professional		$64.57	$95.50	$125.89
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $27.54 / $38.02	Professional	26	$18.20	$27.54	$38.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $66.07 / $89.13	Professional	TC	$42.66	$66.07	$89.13
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $125.89 / $125.89	Facility	26	$125.89	$125.89	$125.89
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $97.72 / $123.03	Professional		$60.26	$97.72	$123.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $29.51 / $38.02	Professional	26	$17.78	$29.51	$38.02
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $67.61 / $85.11	Professional	TC	$42.66	$67.61	$85.11
United Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $102.33 / $141.25	Professional		$66.07	$102.33	$141.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $30.20 / $41.69	Professional	26	$19.05	$30.20	$41.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $72.44 / $100.00	Professional	TC	$45.71	$72.44	$100.00