Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.56 / $26.56 / $29.30	Facility	26	$26.56	$26.56	$29.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.15 / $50.53 / $111.87	Professional		$41.15	$50.53	$111.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.24 / $13.25 / $29.90	Professional	26	$11.24	$13.25	$29.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.92 / $35.83 / $70.73	Professional	TC	$29.92	$35.83	$70.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.40 / $86.50 / $123.56	Professional		$48.40	$86.50	$123.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.31 / $23.00 / $32.50	Professional	26	$13.31	$23.00	$32.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.86 / $63.21 / $92.60	Professional	TC	$34.86	$63.21	$92.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $86.31 / $96.55 / $122.39	Professional		$86.31	$96.55	$122.39
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.41 / $24.94 / $29.66	Professional	26	$21.41	$24.94	$29.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $60.91 / $72.06 / $86.48	Professional	TC	$60.91	$72.06	$86.48
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $61.14 / $78.61 / $117.91	Professional		$61.14	$78.61	$117.91
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $21.51 / $35.58	Professional	26	$15.85	$21.51	$35.58
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.29 / $61.47 / $97.26	Professional	TC	$45.29	$61.47	$97.26
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $16.96 / $23.14 / $23.45	Facility	26	$16.96	$23.14	$23.45
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.39 / $19.95 / $24.89	Professional	26	$15.39	$19.95	$24.89
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $38.29 / $54.45 / $66.33	Professional	TC	$38.29	$54.45	$66.33
Providence Facility/Professional Professional Modifier Low / Median / High Price $60.89 / $91.47 / $117.92	Professional		$60.89	$91.47	$117.92
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.65 / $23.88 / $32.50	Professional	26	$13.65	$23.88	$32.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $36.52 / $64.47 / $92.60	Professional	TC	$36.52	$64.47	$92.60
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $459.43 / $459.43 / $459.43	Facility	26	$459.43	$459.43	$459.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $56.95 / $91.05 / $122.07	Professional		$56.95	$91.05	$122.07
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.88 / $24.94 / $33.15	Professional	26	$14.88	$24.94	$33.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.08 / $66.34 / $89.21	Professional	TC	$42.08	$66.34	$89.21
United Facility/Professional Professional Modifier Low / Median / High Price $59.52 / $86.10 / $134.66	Professional		$59.52	$86.10	$134.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.28 / $24.71 / $37.24	Professional	26	$17.28	$24.71	$37.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.24 / $59.26 / $90.96	Professional	TC	$42.24	$59.26	$90.96