Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.98 / $31.98 / $35.24	Facility	26	$31.98	$31.98	$35.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.61 / $61.17 / $118.84	Professional		$45.61	$61.17	$118.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.12 / $16.85 / $36.08	Professional	26	$13.12	$16.85	$36.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.59 / $44.32 / $82.75	Professional	TC	$31.59	$44.32	$82.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.26 / $100.09 / $146.60	Professional		$63.26	$100.09	$146.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.84 / $28.77 / $43.74	Professional	26	$17.84	$28.77	$43.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.39 / $72.14 / $101.12	Professional	TC	$45.39	$72.14	$101.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $75.65 / $92.74 / $111.82	Professional		$75.65	$92.74	$111.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.13 / $29.41 / $35.28	Professional	26	$25.13	$29.41	$35.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $50.53 / $61.93 / $76.54	Professional	TC	$50.53	$61.93	$76.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $59.36 / $85.36 / $112.92	Professional		$59.36	$85.36	$112.92
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.89 / $24.53 / $42.69	Professional	26	$17.89	$24.53	$42.69
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.25 / $49.67 / $88.07	Professional	TC	$36.25	$49.67	$88.07
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $21.80 / $27.15 / $30.15	Facility	26	$21.80	$27.15	$30.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.29 / $25.63 / $30.94	Professional	26	$17.29	$25.63	$30.94
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $41.41 / $57.17 / $75.44	Professional	TC	$41.41	$57.17	$75.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $66.12 / $98.80 / $128.22	Professional		$66.12	$98.80	$128.22
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.87 / $28.36 / $39.38	Professional	26	$17.87	$28.36	$39.38
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $44.39 / $69.09 / $98.56	Professional	TC	$44.39	$69.09	$98.56
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 $55.30 / $99.52 / $128.86	Professional		$55.30	$99.52	$128.86
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $29.70 / $39.54	Professional	26	$17.07	$29.70	$39.54
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $38.22 / $69.00 / $89.07	Professional	TC	$38.22	$69.00	$89.07
United Facility/Professional Professional Modifier Low / Median / High Price $70.93 / $105.12 / $143.65	Professional		$70.93	$105.12	$143.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.41 / $30.61 / $43.51	Professional	26	$20.41	$30.61	$43.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.52 / $72.09 / $99.51	Professional	TC	$50.52	$72.09	$99.51