Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.25 / $18.84 / $37.36	Facility	26	$14.25	$18.84	$37.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.89 / $43.35 / $181.00	Professional		$29.89	$43.35	$181.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $10.88 / $44.75	Professional	26	$7.33	$10.88	$44.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.57 / $32.47 / $71.11	Professional	TC	$22.57	$32.47	$71.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.30 / $9.30 / $9.30	Facility	26	$9.30	$9.30	$9.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.09 / $67.25 / $104.50	Professional		$35.09	$67.25	$104.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.31 / $16.37 / $24.10	Professional	26	$9.31	$16.37	$24.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.56 / $52.49 / $82.65	Professional	TC	$26.56	$52.49	$82.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $74.34 / $88.55 / $102.68	Professional		$74.34	$88.55	$102.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.96 / $19.12 / $21.52	Professional	26	$15.96	$19.12	$21.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.91 / $69.15 / $81.16	Professional	TC	$57.91	$69.15	$81.16
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $49.50 / $63.96 / $116.91	Professional		$49.50	$63.96	$116.91
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.35 / $16.23 / $25.41	Professional	26	$13.35	$16.23	$25.41
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.60 / $57.55 / $91.50	Professional	TC	$39.60	$57.55	$91.50
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $12.11 / $15.96 / $16.75	Facility	26	$12.11	$15.96	$16.75
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.40 / $14.75 / $18.25	Professional	26	$11.40	$14.75	$18.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $31.66 / $42.34 / $57.62	Professional	TC	$31.66	$42.34	$57.62
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.30 / $9.30 / $9.30	Facility	26	$9.30	$9.30	$9.30
Providence Facility/Professional Professional Modifier Low / Median / High Price $55.08 / $79.09 / $108.30	Professional		$55.08	$79.09	$108.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.25 / $16.77 / $24.10	Professional	26	$11.25	$16.77	$24.10
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $34.94 / $58.11 / $83.51	Professional	TC	$34.94	$58.11	$83.51
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 $62.22 / $77.40 / $104.63	Professional		$62.22	$77.40	$104.63
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.96 / $17.69 / $23.69	Professional	26	$14.96	$17.69	$23.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $46.13 / $60.97 / $81.88	Professional	TC	$46.13	$60.97	$81.88
United Facility/Professional Professional Modifier Low / Median / High Price $32.70 / $42.50 / $105.26	Professional		$32.70	$42.50	$105.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.94 / $10.75 / $25.79	Professional	26	$8.94	$10.75	$25.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.72 / $32.59 / $79.47	Professional	TC	$23.72	$32.59	$79.47