Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.37 / $34.64 / $77.47	Facility	26	$21.37	$34.64	$77.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.27 / $58.57 / $267.47	Professional		$43.27	$58.57	$267.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.65 / $18.32 / $52.86	Professional	26	$12.65	$18.32	$52.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.25 / $41.79 / $83.45	Professional	TC	$30.25	$41.79	$83.45
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.71 / $17.71 / $17.71	Facility	26	$17.71	$17.71	$17.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.92 / $100.54 / $145.36	Professional		$52.92	$100.54	$145.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.09 / $30.41 / $45.24	Professional	26	$17.09	$30.41	$45.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.14 / $68.48 / $105.18	Professional	TC	$36.14	$68.48	$105.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $103.34 / $122.77 / $141.96	Professional		$103.34	$122.77	$141.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.32 / $35.07 / $39.49	Professional	26	$29.32	$35.07	$39.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $73.09 / $87.28 / $102.47	Professional	TC	$73.09	$87.28	$102.47
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $77.28 / $91.40 / $157.59	Professional		$77.28	$91.40	$157.59
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $30.06 / $46.77	Professional	26	$24.55	$30.06	$46.77
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.24 / $72.51 / $113.85	Professional	TC	$59.24	$72.51	$113.85
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $22.77 / $30.23 / $31.49	Facility	26	$22.77	$30.23	$31.49
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.89 / $27.14 / $32.43	Professional	26	$18.89	$27.14	$32.43
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $39.40 / $59.63 / $71.69	Professional	TC	$39.40	$59.63	$71.69
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $17.71 / $17.71 / $17.71	Facility	26	$17.71	$17.71	$17.71
Providence Facility/Professional Professional Modifier Low / Median / High Price $79.06 / $112.65 / $149.15	Professional		$79.06	$112.65	$149.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $20.39 / $31.18 / $45.28	Professional	26	$20.39	$31.18	$45.28
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $47.27 / $73.80 / $105.18	Professional	TC	$47.27	$73.80	$105.18
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 $94.56 / $108.39 / $143.75	Professional		$94.56	$108.39	$143.75
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $27.53 / $33.25 / $43.59	Professional	26	$27.53	$33.25	$43.59
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $64.38 / $76.72 / $102.16	Professional	TC	$64.38	$76.72	$102.16
United Facility/Professional Professional Modifier Low / Median / High Price $47.43 / $66.23 / $148.84	Professional		$47.43	$66.23	$148.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.48 / $20.48 / $47.54	Professional	26	$16.48	$20.48	$47.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.94 / $45.98 / $116.02	Professional	TC	$31.94	$45.98	$116.02