Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.04 / $25.54 / $59.20	Facility	26	$20.04	$25.54	$59.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.54 / $47.75 / $211.00	Professional		$33.54	$47.75	$211.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.69 / $13.94 / $31.21	Professional	26	$9.69	$13.94	$31.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.97 / $33.90 / $80.92	Professional	TC	$23.97	$33.90	$80.92
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.50 / $13.50 / $13.50	Facility	26	$13.50	$13.50	$13.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.72 / $76.50 / $120.85	Professional		$40.72	$76.50	$120.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.56 / $23.37 / $34.79	Professional	26	$13.56	$23.37	$34.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.94 / $56.22 / $89.19	Professional	TC	$27.94	$56.22	$89.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $86.31 / $102.59 / $118.75	Professional		$86.31	$102.59	$118.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.07 / $27.63 / $31.10	Professional	26	$23.07	$27.63	$31.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $62.53 / $74.67 / $87.65	Professional	TC	$62.53	$74.67	$87.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $62.37 / $74.15 / $132.15	Professional		$62.37	$74.15	$132.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.21 / $24.83 / $38.18	Professional	26	$19.21	$24.83	$38.18
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.86 / $63.24 / $96.57	Professional	TC	$46.86	$63.24	$96.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.64 / $23.14 / $24.12	Facility	26	$17.64	$23.14	$24.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.40 / $21.60 / $25.20	Professional	26	$14.40	$21.60	$25.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $32.38 / $46.90 / $59.94	Professional	TC	$32.38	$46.90	$59.94
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.50 / $13.50 / $13.50	Facility	26	$13.50	$13.50	$13.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $64.01 / $91.70 / $124.45	Professional		$64.01	$91.70	$124.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.86 / $24.53 / $34.79	Professional	26	$15.86	$24.53	$34.79
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.20 / $62.75 / $90.10	Professional	TC	$37.20	$62.75	$90.10
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $72.95 / $89.74 / $119.49	Professional		$72.95	$89.74	$119.49
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $20.95 / $25.47 / $33.15	Professional	26	$20.95	$25.47	$33.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $51.04 / $65.30 / $87.56	Professional	TC	$51.04	$65.30	$87.56
United Facility/Professional Professional Modifier Low / Median / High Price $38.09 / $52.33 / $122.82	Professional		$38.09	$52.33	$122.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.90 / $14.19 / $36.89	Professional	26	$12.90	$14.19	$36.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.15 / $38.95 / $85.80	Professional	TC	$25.15	$38.95	$85.80