Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.72 / $25.91 / $52.37	Facility	26	$17.72	$25.91	$52.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.69 / $42.46 / $184.33	Professional		$30.69	$42.46	$184.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.58 / $12.35 / $33.77	Professional	26	$8.58	$12.35	$33.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.12 / $29.94 / $68.34	Professional	TC	$22.12	$29.94	$68.34
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.95 / $11.95 / $11.95	Facility	26	$11.95	$11.95	$11.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.25 / $73.28 / $108.75	Professional		$41.25	$73.28	$108.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.20 / $22.08 / $32.71	Professional	26	$13.20	$22.08	$32.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.41 / $50.27 / $76.94	Professional	TC	$29.41	$50.27	$76.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $74.40 / $88.44 / $102.32	Professional		$74.40	$88.44	$102.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.85 / $23.73 / $26.72	Professional	26	$19.85	$23.73	$26.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $53.94 / $64.40 / $75.59	Professional	TC	$53.94	$64.40	$75.59
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $57.68 / $71.50 / $113.42	Professional		$57.68	$71.50	$113.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.55 / $22.05 / $31.53	Professional	26	$16.55	$22.05	$31.53
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.76 / $53.03 / $83.37	Professional	TC	$43.76	$53.03	$83.37
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.04 / $20.46 / $24.12	Facility	26	$17.04	$20.46	$24.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.12 / $20.88 / $25.20	Professional	26	$15.12	$20.88	$25.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $32.83 / $44.85 / $55.30	Professional	TC	$32.83	$44.85	$55.30
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.95 / $11.95 / $11.95	Facility	26	$11.95	$11.95	$11.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $60.79 / $81.68 / $109.61	Professional		$60.79	$81.68	$109.61
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.04 / $22.82 / $34.65	Professional	26	$14.04	$22.82	$34.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $54.13 / $76.94	Professional	TC	$37.15	$54.13	$76.94
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 $67.63 / $78.54 / $103.07	Professional		$67.63	$78.54	$103.07
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.55 / $23.04 / $29.37	Professional	26	$18.55	$23.04	$29.37
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.39 / $56.99 / $74.79	Professional	TC	$48.39	$56.99	$74.79
United Facility/Professional Professional Modifier Low / Median / High Price $37.17 / $43.74 / $117.06	Professional		$37.17	$43.74	$117.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.55 / $12.94 / $32.78	Professional	26	$11.55	$12.94	$32.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.70 / $36.90 / $73.26	Professional	TC	$24.70	$36.90	$73.26