Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.62 / $31.98 / $35.24	Facility	26	$28.62	$31.98	$35.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.14 / $45.92 / $164.92	Professional		$37.14	$45.92	$164.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.69 / $18.30 / $58.99	Professional	26	$13.69	$18.30	$58.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.42 / $27.61 / $53.61	Professional	TC	$23.42	$27.61	$53.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.40 / $76.06 / $107.15	Professional		$42.40	$76.06	$107.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.90 / $27.67 / $38.43	Professional	26	$15.90	$27.67	$38.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.95 / $48.40 / $69.94	Professional	TC	$26.95	$48.40	$69.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $74.81 / $83.12 / $105.33	Professional		$74.81	$83.12	$105.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.72 / $29.96 / $35.63	Professional	26	$25.72	$29.96	$35.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $45.64 / $53.97 / $64.78	Professional	TC	$45.64	$53.97	$64.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $49.21 / $67.70 / $98.12	Professional		$49.21	$67.70	$98.12
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.71 / $26.09 / $41.75	Professional	26	$19.71	$26.09	$41.75
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.54 / $44.88 / $73.20	Professional	TC	$31.54	$44.88	$73.20
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.35 / $27.81 / $28.56	Facility	26	$20.35	$27.81	$28.56
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $16.88 / $24.78 / $30.24	Professional	26	$16.88	$24.78	$30.24
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.61 / $39.90 / $50.72	Professional	TC	$28.61	$39.90	$50.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $53.53 / $79.91 / $103.46	Professional		$53.53	$79.91	$103.46
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.82 / $28.70 / $38.43	Professional	26	$16.82	$28.70	$38.43
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.17 / $50.11 / $70.31	Professional	TC	$28.17	$50.11	$70.31
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 / $80.51 / $107.05	Professional		$49.72	$80.51	$107.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.85 / $29.89 / $39.79	Professional	26	$17.85	$29.89	$39.79
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $31.88 / $50.85 / $67.61	Professional	TC	$31.88	$50.85	$67.61
United Facility/Professional Professional Modifier Low / Median / High Price $52.01 / $76.83 / $112.75	Professional		$52.01	$76.83	$112.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.80 / $29.22 / $43.01	Professional	26	$19.80	$29.22	$43.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.28 / $47.30 / $69.69	Professional	TC	$31.28	$47.30	$69.69