Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.79 / $28.46 / $57.57	Facility	26	$24.79	$28.46	$57.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.46 / $59.91 / $265.00	Professional		$43.46	$59.91	$265.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.27 / $13.52 / $36.54	Professional	26	$9.27	$13.52	$36.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.47 / $41.31 / $104.32	Professional	TC	$31.47	$41.31	$104.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.10 / $13.10 / $13.10	Facility	26	$13.10	$13.10	$13.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.93 / $93.16 / $147.32	Professional		$50.93	$93.16	$147.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.17 / $22.92 / $33.84	Professional	26	$13.17	$22.92	$33.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.61 / $74.06 / $117.47	Professional	TC	$38.61	$74.06	$117.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.81 / $124.75 / $144.77	Professional		$104.81	$124.75	$144.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.78 / $26.06 / $29.34	Professional	26	$21.78	$26.06	$29.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $82.36 / $98.34 / $115.43	Professional	TC	$82.36	$98.34	$115.43
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $74.97 / $90.00 / $161.63	Professional		$74.97	$90.00	$161.63
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.14 / $22.98 / $34.56	Professional	26	$18.14	$22.98	$34.56
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.38 / $81.39 / $127.08	Professional	TC	$61.38	$81.39	$127.08
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.64 / $22.46 / $24.12	Facility	26	$17.64	$22.46	$24.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.47 / $20.88 / $26.46	Professional	26	$14.47	$20.88	$26.46
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $44.22 / $62.06 / $85.53	Professional	TC	$44.22	$62.06	$85.53
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.10 / $13.10 / $13.10	Facility	26	$13.10	$13.10	$13.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $77.88 / $111.30 / $152.00	Professional		$77.88	$111.30	$152.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.40 / $23.73 / $33.84	Professional	26	$15.40	$23.73	$33.84
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $51.37 / $82.75 / $117.47	Professional	TC	$51.37	$82.75	$117.47
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 $89.60 / $109.17 / $146.16	Professional		$89.60	$109.17	$146.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $20.35 / $24.76 / $32.21	Professional	26	$20.35	$24.76	$32.21
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $67.65 / $85.63 / $114.92	Professional	TC	$67.65	$85.63	$114.92
United Facility/Professional Professional Modifier Low / Median / High Price $47.43 / $75.40 / $164.72	Professional		$47.43	$75.40	$164.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.00 / $14.19 / $35.84	Professional	26	$12.00	$14.19	$35.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.19 / $46.66 / $113.70	Professional	TC	$34.19	$46.66	$113.70