Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.72 / $23.49 / $52.37	Facility	26	$17.72	$23.49	$52.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.67 / $46.87 / $207.00	Professional		$33.67	$46.87	$207.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.46 / $12.04 / $26.60	Professional	26	$8.46	$12.04	$26.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.22 / $32.84 / $77.55	Professional	TC	$23.22	$32.84	$77.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.95 / $11.95 / $11.95	Facility	26	$11.95	$11.95	$11.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.76 / $72.84 / $114.44	Professional		$39.76	$72.84	$114.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.01 / $20.76 / $30.48	Professional	26	$12.01	$20.76	$30.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.75 / $55.03 / $86.37	Professional	TC	$28.75	$55.03	$86.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.01 / $96.33 / $111.59	Professional		$81.01	$96.33	$111.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.85 / $23.73 / $26.72	Professional	26	$19.85	$23.73	$26.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $60.54 / $72.29 / $84.87	Professional	TC	$60.54	$72.29	$84.87
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $58.80 / $69.63 / $126.06	Professional		$58.80	$69.63	$126.06
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.55 / $20.26 / $31.53	Professional	26	$16.55	$20.26	$31.53
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.18 / $60.14 / $94.56	Professional	TC	$48.18	$60.14	$94.56
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $15.68 / $20.46 / $21.44	Facility	26	$15.68	$20.46	$21.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.86 / $18.23 / $23.04	Professional	26	$12.86	$18.23	$23.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.15 / $42.75 / $54.60	Professional	TC	$30.15	$42.75	$54.60
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.95 / $11.95 / $11.95	Facility	26	$11.95	$11.95	$11.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $60.39 / $86.80 / $117.80	Professional		$60.39	$86.80	$117.80
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.04 / $21.60 / $30.48	Professional	26	$14.04	$21.60	$30.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.68 / $60.76 / $87.28	Professional	TC	$37.68	$60.76	$87.28
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 $68.48 / $84.94 / $113.38	Professional		$68.48	$84.94	$113.38
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.55 / $22.09 / $29.37	Professional	26	$18.55	$22.09	$29.37
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $49.20 / $63.71 / $84.83	Professional	TC	$49.20	$63.71	$84.83
United Facility/Professional Professional Modifier Low / Median / High Price $36.29 / $42.16 / $115.58	Professional		$36.29	$42.16	$115.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.46 / $12.39 / $32.69	Professional	26	$11.46	$12.39	$32.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.77 / $33.60 / $82.55	Professional	TC	$24.77	$33.60	$82.55