Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.23 / $27.12 / $58.90	Facility	26	$18.23	$27.12	$58.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.71 / $73.84 / $205.00	Professional		$47.71	$73.84	$205.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.02 / $20.18 / $57.00	Professional	26	$13.02	$20.18	$57.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.09 / $48.72 / $112.34	Professional	TC	$34.09	$48.72	$112.34
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 $52.54 / $96.91 / $149.91	Professional		$52.54	$96.91	$149.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.05 / $27.48 / $40.19	Professional	26	$17.05	$27.48	$40.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.92 / $70.75 / $115.59	Professional	TC	$35.92	$70.75	$115.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $106.82 / $127.05 / $147.31	Professional		$106.82	$127.05	$147.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.02 / $29.95 / $33.72	Professional	26	$25.02	$29.95	$33.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.03 / $96.75 / $113.59	Professional	TC	$81.03	$96.75	$113.59
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $76.80 / $93.06 / $162.66	Professional		$76.80	$93.06	$162.66
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.09 / $27.72 / $41.39	Professional	26	$22.09	$27.72	$41.39
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $65.34 / $76.80 / $123.00	Professional	TC	$65.34	$76.80	$123.00
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.90 / $25.46 / $30.15	Facility	26	$20.90	$25.46	$30.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.48 / $26.20 / $31.61	Professional	26	$18.48	$26.20	$31.61
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $38.64 / $55.61 / $74.00	Professional	TC	$38.64	$55.61	$74.00
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 $77.65 / $112.70 / $151.32	Professional		$77.65	$112.70	$151.32
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.67 / $28.71 / $42.58	Professional	26	$17.67	$28.71	$42.58
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $45.62 / $78.59 / $115.59	Professional	TC	$45.62	$78.59	$115.59
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 $89.06 / $111.53 / $145.57	Professional		$89.06	$111.53	$145.57
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.34 / $29.44 / $36.95	Professional	26	$23.34	$29.44	$36.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $61.50 / $82.78 / $110.09	Professional	TC	$61.50	$82.78	$110.09
United Facility/Professional Professional Modifier Low / Median / High Price $45.94 / $64.31 / $146.78	Professional		$45.94	$64.31	$146.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $18.13 / $40.29	Professional	26	$14.07	$18.13	$40.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.79 / $43.68 / $107.22	Professional	TC	$29.79	$43.68	$107.22