Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.97 / $23.38 / $47.22	Facility	26	$15.97	$23.38	$47.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.75 / $39.04 / $153.28	Professional		$27.75	$39.04	$153.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.83 / $11.16 / $25.72	Professional	26	$7.83	$11.16	$25.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.68 / $26.31 / $57.06	Professional	TC	$19.68	$26.31	$57.06
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.80 / $10.80 / $10.80	Facility	26	$10.80	$10.80	$10.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.01 / $62.65 / $92.92	Professional		$34.01	$62.65	$92.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.86 / $18.80 / $27.53	Professional	26	$10.86	$18.80	$27.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $43.14 / $67.79	Professional	TC	$23.99	$43.14	$67.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $65.79 / $78.19 / $90.43	Professional		$65.79	$78.19	$90.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.89 / $21.38 / $24.07	Professional	26	$17.89	$21.38	$24.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.33 / $56.51 / $66.33	Professional	TC	$47.33	$56.51	$66.33
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $40.76 / $56.61 / $101.38	Professional		$40.76	$56.61	$101.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.95 / $18.76 / $28.47	Professional	26	$14.95	$18.76	$28.47
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.43 / $50.67 / $74.22	Professional	TC	$38.43	$50.67	$74.22
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.21 / $18.46 / $19.43	Facility	26	$14.21	$18.46	$19.43
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.66 / $17.11 / $20.72	Professional	26	$11.66	$17.11	$20.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $24.92 / $36.18 / $46.90	Professional	TC	$24.92	$36.18	$46.90
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.80 / $10.80 / $10.80	Facility	26	$10.80	$10.80	$10.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $50.18 / $71.63 / $95.95	Professional		$50.18	$71.63	$95.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.68 / $19.27 / $27.99	Professional	26	$12.68	$19.27	$27.99
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.58 / $47.50 / $68.43	Professional	TC	$29.58	$47.50	$68.43
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 $57.95 / $69.19 / $92.12	Professional		$57.95	$69.19	$92.12
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.76 / $20.52 / $26.53	Professional	26	$16.76	$20.52	$26.53
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $40.26 / $50.01 / $66.58	Professional	TC	$40.26	$50.01	$66.58
United Facility/Professional Professional Modifier Low / Median / High Price $29.79 / $43.16 / $95.09	Professional		$29.79	$43.16	$95.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.39 / $11.32 / $29.71	Professional	26	$10.39	$11.32	$29.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $24.56 / $65.00	Professional	TC	$19.05	$24.56	$65.00