Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.50 / $33.11 / $52.48	Facility	26	$19.50	$33.11	$52.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $89.13 / $288.40	Professional		$52.48	$89.13	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $19.95 / $61.66	Professional	26	$12.02	$19.95	$61.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $53.70 / $112.20	Professional	TC	$37.15	$53.70	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $120.23 / $177.83	Professional		$64.57	$120.23	$177.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $29.51 / $47.86	Professional	26	$18.62	$29.51	$47.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $91.20 / $138.04	Professional	TC	$44.67	$91.20	$138.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $134.90 / $169.82	Professional		$120.23	$134.90	$169.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $30.90 / $37.15	Professional	26	$27.54	$30.90	$37.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $104.71 / $131.83	Professional	TC	$93.33	$104.71	$131.83
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $19.50 / $36.31 / $57.54	Facility	26	$19.50	$36.31	$57.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $117.49 / $186.21	Professional		$72.44	$117.49	$186.21
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $29.51 / $42.66	Professional	26	$16.22	$29.51	$42.66
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $93.33 / $131.83	Professional	TC	$51.29	$93.33	$131.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $23.44 / $28.18 / $34.67	Facility	26	$23.44	$28.18	$34.67
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $28.18 / $35.48	Professional	26	$20.89	$28.18	$35.48
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $70.79 / $89.13	Professional	TC	$50.12	$70.79	$89.13
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.55 / $16.60 / $23.44	Facility	26	$3.55	$16.60	$23.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $128.82 / $181.97	Professional		$97.72	$128.82	$181.97
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $34.67 / $44.67	Professional	26	$21.88	$34.67	$44.67
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $91.20 / $138.04	Professional	TC	$63.10	$91.20	$138.04
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $128.82 / $165.96	Professional		$107.15	$128.82	$165.96
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $33.11 / $41.69	Professional	26	$25.70	$33.11	$41.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $95.50 / $125.89	Professional	TC	$72.44	$95.50	$125.89
United Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $75.86 / $162.18	Professional		$56.23	$75.86	$162.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $19.50 / $43.65	Professional	26	$15.49	$19.50	$43.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $53.70 / $125.89	Professional	TC	$38.02	$53.70	$125.89