Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.82 / $19.61 / $43.91	Facility	26	$14.82	$19.61	$43.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.87 / $37.71 / $105.96	Professional		$29.87	$37.71	$105.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.26 / $10.15 / $23.43	Professional	26	$7.26	$10.15	$23.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.94 / $28.86 / $69.13	Professional	TC	$21.94	$28.86	$69.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.01 / $10.01 / $10.01	Facility	26	$10.01	$10.01	$10.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.15 / $67.81 / $107.25	Professional		$35.15	$67.81	$107.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.71 / $17.03 / $25.11	Professional	26	$9.71	$17.03	$25.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.82 / $52.12 / $84.48	Professional	TC	$25.82	$52.12	$84.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $76.34 / $90.90 / $105.38	Professional		$76.34	$90.90	$105.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $19.88 / $22.38	Professional	26	$16.60	$19.88	$22.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $59.22 / $70.70 / $83.03	Professional	TC	$59.22	$70.70	$83.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $53.00 / $65.66 / $117.93	Professional		$53.00	$65.66	$117.93
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.88 / $17.75 / $26.43	Professional	26	$13.88	$17.75	$26.43
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.61 / $58.86 / $91.50	Professional	TC	$37.61	$58.86	$91.50
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $12.74 / $16.89 / $17.42	Facility	26	$12.74	$16.89	$17.42
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.92 / $15.39 / $19.11	Professional	26	$10.92	$15.39	$19.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.55 / $41.87 / $58.71	Professional	TC	$30.55	$41.87	$58.71
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.01 / $10.01 / $10.01	Facility	26	$10.01	$10.01	$10.01
Providence Facility/Professional Professional Modifier Low / Median / High Price $55.69 / $80.26 / $109.25	Professional		$55.69	$80.26	$109.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.78 / $17.48 / $25.57	Professional	26	$11.78	$17.48	$25.57
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $33.97 / $58.69 / $85.39	Professional	TC	$33.97	$58.69	$85.39
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $209.36 / $209.36 / $209.36	Facility	26	$209.36	$209.36	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $63.54 / $80.15 / $105.54	Professional		$63.54	$80.15	$105.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.56 / $18.39 / $24.64	Professional	26	$15.56	$18.39	$24.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $47.36 / $61.62 / $81.88	Professional	TC	$47.36	$61.62	$81.88
United Facility/Professional Professional Modifier Low / Median / High Price $33.06 / $40.17 / $106.45	Professional		$33.06	$40.17	$106.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.81 / $10.14 / $26.82	Professional	26	$8.81	$10.14	$26.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.72 / $30.50 / $79.59	Professional	TC	$23.72	$30.50	$79.59