Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.15 / $53.92 / $61.64	Facility	26	$44.15	$53.92	$61.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $59.67 / $74.00 / $259.00	Professional		$59.67	$74.00	$259.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.64 / $33.60 / $78.04	Professional	26	$26.64	$33.60	$78.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.93 / $39.52 / $76.59	Professional	TC	$32.93	$39.52	$76.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.54 / $119.53 / $169.89	Professional		$66.54	$119.53	$169.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.53 / $53.59 / $75.02	Professional	26	$30.53	$53.59	$75.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.00 / $64.68 / $99.13	Professional	TC	$36.00	$64.68	$99.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $121.01 / $134.91 / $170.00	Professional		$121.01	$134.91	$170.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $49.61 / $57.78 / $68.72	Professional	26	$49.61	$57.78	$68.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.20 / $78.31 / $93.98	Professional	TC	$66.20	$78.31	$93.98
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $81.38 / $106.64 / $156.63	Professional		$81.38	$106.64	$156.63
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.29 / $51.84 / $79.56	Professional	26	$39.29	$51.84	$79.56
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $47.36 / $63.47 / $106.08	Professional	TC	$47.36	$63.47	$106.08
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $40.18 / $53.61 / $55.27	Facility	26	$40.18	$53.61	$55.27
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $39.70 / $52.93 / $55.70	Professional		$39.70	$52.93	$55.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.96 / $48.38 / $59.04	Professional	26	$32.96	$48.38	$59.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $36.08 / $52.44 / $67.50	Professional	TC	$36.08	$52.44	$67.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $83.74 / $126.82 / $164.59	Professional		$83.74	$126.82	$164.59
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $32.40 / $55.65 / $75.02	Professional	26	$32.40	$55.65	$75.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.46 / $67.55 / $99.13	Professional	TC	$37.46	$67.55	$99.13
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 $80.33 / $128.46 / $170.90	Professional		$80.33	$128.46	$170.90
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $34.43 / $57.92 / $76.75	Professional	26	$34.43	$57.92	$76.75
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $45.90 / $70.58 / $95.70	Professional	TC	$45.90	$70.58	$95.70
United Facility/Professional Professional Modifier Low / Median / High Price $81.83 / $116.90 / $174.53	Professional		$81.83	$116.90	$174.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.90 / $55.89 / $83.02	Professional	26	$36.90	$55.89	$83.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.14 / $58.48 / $94.15	Professional	TC	$42.14	$58.48	$94.15