Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.07 / $20.35 / $133.46	Facility	26	$13.07	$20.35	$133.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.72 / $66.48 / $290.00	Professional		$43.72	$66.48	$290.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.37 / $16.68 / $61.00	Professional	26	$10.37	$16.68	$61.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.58 / $50.15 / $79.95	Professional	TC	$31.58	$50.15	$79.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.97 / $93.92 / $137.59	Professional		$56.97	$93.92	$137.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.51 / $22.19 / $30.43	Professional	26	$13.51	$22.19	$30.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.36 / $72.80 / $105.22	Professional	TC	$43.36	$72.80	$105.22
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $74.73 / $83.63 / $106.01	Professional		$74.73	$83.63	$106.01
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $18.32 / $21.34 / $25.38	Professional	26	$18.32	$21.34	$25.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $52.98 / $62.67 / $75.20	Professional	TC	$52.98	$62.67	$75.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $56.78 / $88.95 / $116.91	Professional		$56.78	$88.95	$116.91
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $19.39 / $29.84	Professional	26	$14.07	$19.39	$29.84
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.65 / $56.28 / $86.40	Professional	TC	$41.65	$56.28	$86.40
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $16.48 / $19.80 / $24.79	Facility	26	$16.48	$19.80	$24.79
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.80 / $21.18 / $27.64	Professional	26	$14.80	$21.18	$27.64
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $47.44 / $70.02 / $97.20	Professional	TC	$47.44	$70.02	$97.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $69.75 / $92.61 / $126.19	Professional		$69.75	$92.61	$126.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.63 / $22.66 / $30.43	Professional	26	$13.63	$22.66	$30.43
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $46.47 / $75.27 / $105.22	Professional	TC	$46.47	$75.27	$105.22
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $838.61 / $838.61 / $838.61	Facility	26	$838.61	$838.61	$838.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $49.72 / $90.79 / $126.50	Professional		$49.72	$90.79	$126.50
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.75 / $22.57 / $31.07	Professional	26	$12.75	$22.57	$31.07
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $36.97 / $68.56 / $97.94	Professional	TC	$36.97	$68.56	$97.94
United Facility/Professional Professional Modifier Low / Median / High Price $76.81 / $110.22 / $151.37	Professional		$76.81	$110.22	$151.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.28 / $25.22 / $33.31	Professional	26	$17.28	$25.22	$33.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.41 / $85.81 / $119.61	Professional	TC	$59.41	$85.81	$119.61