Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.10 / $32.40 / $66.91	Facility	26	$24.10	$32.40	$66.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.98 / $74.93 / $293.41	Professional		$58.98	$74.93	$293.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $19.60 / $46.45	Professional	26	$12.88	$19.60	$46.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.65 / $55.17 / $141.61	Professional	TC	$38.65	$55.17	$141.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.57 / $16.57 / $16.57	Facility	26	$16.57	$16.57	$16.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $65.13 / $119.86 / $173.78	Professional		$65.13	$119.86	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.67 / $31.80 / $45.15	Professional	26	$19.67	$31.80	$45.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.44 / $85.35 / $134.44	Professional	TC	$45.44	$85.35	$134.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $122.48 / $145.76 / $168.99	Professional		$122.48	$145.76	$168.99
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.39 / $32.74 / $36.86	Professional	26	$27.39	$32.74	$36.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $94.25 / $112.53 / $132.12	Professional	TC	$94.25	$112.53	$132.12
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $94.64 / $108.29 / $190.11	Professional		$94.64	$108.29	$190.11
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.95 / $31.82 / $43.71	Professional	26	$22.95	$31.82	$43.71
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $76.33 / $93.77 / $146.40	Professional	TC	$76.33	$93.77	$146.40
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $23.63 / $28.23 / $34.84	Facility	26	$23.63	$28.23	$34.84
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $20.80 / $28.98 / $35.51	Professional	26	$20.80	$28.98	$35.51
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $49.71 / $71.02 / $85.94	Professional	TC	$49.71	$71.02	$85.94
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.57 / $16.57 / $16.57	Facility	26	$16.57	$16.57	$16.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $94.54 / $133.19 / $178.60	Professional		$94.54	$133.19	$178.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.77 / $32.04 / $47.85	Professional	26	$19.77	$32.04	$47.85
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $58.30 / $95.08 / $136.28	Professional	TC	$58.30	$95.08	$136.28
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 $111.92 / $130.66 / $170.13	Professional		$111.92	$130.66	$170.13
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $25.74 / $33.33 / $40.84	Professional	26	$25.74	$33.33	$40.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $82.35 / $97.59 / $131.01	Professional	TC	$82.35	$97.59	$131.01
United Facility/Professional Professional Modifier Low / Median / High Price $56.70 / $72.04 / $172.61	Professional		$56.70	$72.04	$172.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.52 / $19.04 / $44.45	Professional	26	$15.52	$19.04	$44.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.64 / $58.17 / $159.34	Professional	TC	$38.64	$58.17	$159.34