Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.54 / $31.18 / $69.55	Facility	26	$23.54	$31.18	$69.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.65 / $46.27 / $216.00	Professional		$35.65	$46.27	$216.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.38 / $15.64 / $34.32	Professional	26	$11.38	$15.64	$34.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.47 / $31.64 / $75.86	Professional	TC	$22.47	$31.64	$75.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.80 / $15.80 / $15.80	Facility	26	$15.80	$15.80	$15.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.95 / $78.68 / $121.44	Professional		$43.95	$78.68	$121.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $27.04 / $40.32	Professional	26	$14.36	$27.04	$40.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.85 / $53.84 / $84.48	Professional	TC	$29.85	$53.84	$84.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $86.35 / $102.49 / $118.47	Professional		$86.35	$102.49	$118.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.32 / $31.48 / $35.44	Professional	26	$26.32	$31.48	$35.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $59.22 / $70.70 / $83.03	Professional	TC	$59.22	$70.70	$83.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $64.95 / $74.97 / $131.49	Professional		$64.95	$74.97	$131.49
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $26.52 / $41.67	Professional	26	$21.88	$26.52	$41.67
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.03 / $58.45 / $92.52	Professional	TC	$48.03	$58.45	$92.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $19.11 / $26.43 / $27.88	Facility	26	$19.11	$26.43	$27.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.55 / $24.96 / $29.74	Professional	26	$17.55	$24.96	$29.74
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.17 / $46.80 / $60.84	Professional	TC	$33.17	$46.80	$60.84
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $15.80 / $15.80 / $15.80	Facility	26	$15.80	$15.80	$15.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $65.15 / $92.40 / $124.90	Professional		$65.15	$92.40	$124.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $18.43 / $27.53 / $40.65	Professional	26	$18.43	$27.53	$40.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $38.22 / $59.38 / $85.39	Professional	TC	$38.22	$59.38	$85.39
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 $74.88 / $91.11 / $120.09	Professional		$74.88	$91.11	$120.09
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $29.72 / $38.85	Professional	26	$23.99	$29.72	$38.85
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $50.63 / $62.34 / $82.79	Professional	TC	$50.63	$62.34	$82.79
United Facility/Professional Professional Modifier Low / Median / High Price $37.59 / $47.19 / $124.88	Professional		$37.59	$47.19	$124.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.97 / $16.38 / $43.35	Professional	26	$13.97	$16.38	$43.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.36 / $37.06 / $81.53	Professional	TC	$23.36	$37.06	$81.53