Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.76 / $28.82 / $59.59	Facility	26	$17.76	$28.82	$59.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.27 / $50.36 / $163.22	Professional		$28.27	$50.36	$163.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.50 / $17.05 / $57.37	Professional	26	$11.50	$17.05	$57.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.12 / $40.17 / $76.00	Professional	TC	$24.12	$40.17	$76.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.65 / $14.65 / $14.65	Facility	26	$14.65	$14.65	$14.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.90 / $77.79 / $116.88	Professional		$41.90	$77.79	$116.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $25.16 / $37.36	Professional	26	$14.36	$25.16	$37.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.46 / $52.66 / $82.60	Professional	TC	$27.46	$52.66	$82.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.04 / $98.59 / $113.98	Professional		$83.04	$98.59	$113.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.38 / $29.15 / $32.82	Professional	26	$24.38	$29.15	$32.82
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 $60.69 / $71.33 / $126.47	Professional		$60.69	$71.33	$126.47
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.28 / $24.83 / $38.64	Professional	26	$20.28	$24.83	$38.64
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.20 / $56.97 / $90.48	Professional	TC	$46.20	$56.97	$90.48
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $19.11 / $25.13 / $26.13	Facility	26	$19.11	$25.13	$26.13
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.28 / $21.66 / $28.50	Professional	26	$15.28	$21.66	$28.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.08 / $42.88 / $57.90	Professional	TC	$30.08	$42.88	$57.90
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.65 / $14.65 / $14.65	Facility	26	$14.65	$14.65	$14.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $62.67 / $89.01 / $119.70	Professional		$62.67	$89.01	$119.70
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.21 / $25.99 / $37.46	Professional	26	$17.21	$25.99	$37.46
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.14 / $58.01 / $83.51	Professional	TC	$37.14	$58.01	$83.51
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 $72.56 / $87.18 / $115.54	Professional		$72.56	$87.18	$115.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $22.74 / $27.59 / $36.01	Professional	26	$22.74	$27.59	$36.01
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $49.02 / $60.97 / $80.97	Professional	TC	$49.02	$60.97	$80.97
United Facility/Professional Professional Modifier Low / Median / High Price $36.97 / $50.74 / $118.67	Professional		$36.97	$50.74	$118.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.03 / $16.57 / $39.38	Professional	26	$13.03	$16.57	$39.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.64 / $30.16 / $79.47	Professional	TC	$22.64	$30.16	$79.47