Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.38 / $29.75 / $39.64	Facility	26	$24.38	$29.75	$39.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.74 / $83.60 / $216.00	Professional		$55.74	$83.60	$216.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.21 / $25.62 / $79.00	Professional	26	$18.21	$25.62	$79.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.97 / $48.36 / $97.65	Professional	TC	$36.97	$48.36	$97.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.30 / $112.62 / $168.08	Professional		$67.30	$112.62	$168.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.00 / $37.40 / $53.50	Professional	26	$23.00	$37.40	$53.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.03 / $75.04 / $114.87	Professional	TC	$46.03	$75.04	$114.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $96.03 / $111.92 / $135.37	Professional		$96.03	$111.92	$135.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.90 / $38.99 / $44.94	Professional	26	$32.90	$38.99	$44.94
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $62.58 / $73.22 / $90.43	Professional	TC	$62.58	$73.22	$90.43
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $78.08 / $93.62 / $153.51	Professional		$78.08	$93.62	$153.51
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.75 / $36.10 / $55.17	Professional	26	$27.75	$36.10	$55.17
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.31 / $71.33 / $103.98	Professional	TC	$52.31	$71.33	$103.98
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $25.48 / $34.47 / $37.04	Facility	26	$25.48	$34.47	$37.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $23.71 / $30.16 / $39.00	Professional	26	$23.71	$30.16	$39.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $42.42 / $58.73 / $80.52	Professional	TC	$42.42	$58.73	$80.52
Providence Facility/Professional Professional Modifier Low / Median / High Price $87.90 / $115.35 / $147.97	Professional		$87.90	$115.35	$147.97
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.56 / $38.29 / $50.30	Professional	26	$23.56	$38.29	$50.30
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $45.75 / $74.44 / $99.28	Professional	TC	$45.75	$74.44	$99.28
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $95.51 / $118.64 / $144.81	Professional		$95.51	$118.64	$144.81
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $32.89 / $40.59 / $49.27	Professional	26	$32.89	$40.59	$49.27
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $62.68 / $78.05 / $94.94	Professional	TC	$62.68	$78.05	$94.94
United Facility/Professional Professional Modifier Low / Median / High Price $66.93 / $107.10 / $160.65	Professional		$66.93	$107.10	$160.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.63 / $35.36 / $53.87	Professional	26	$21.63	$35.36	$53.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.18 / $74.45 / $105.33	Professional	TC	$40.18	$74.45	$105.33