Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.85 / $24.23 / $50.35	Facility	26	$17.85	$24.23	$50.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.17 / $44.46 / $181.12	Professional		$34.17	$44.46	$181.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.41 / $13.96 / $30.91	Professional	26	$9.41	$13.96	$30.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.21 / $33.04 / $79.95	Professional	TC	$23.21	$33.04	$79.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.36 / $12.36 / $12.36	Facility	26	$12.36	$12.36	$12.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.20 / $73.31 / $108.75	Professional		$40.20	$73.31	$108.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.01 / $20.74 / $30.04	Professional	26	$12.01	$20.74	$30.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.12 / $50.87 / $80.70	Professional	TC	$29.12	$50.87	$80.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $77.72 / $92.36 / $106.86	Professional		$77.72	$92.36	$106.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.50 / $24.47 / $27.55	Professional	26	$20.50	$24.47	$27.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.59 / $67.56 / $79.31	Professional	TC	$56.59	$67.56	$79.31
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $57.23 / $68.90 / $119.97	Professional		$57.23	$68.90	$119.97
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $20.70 / $32.52	Professional	26	$17.07	$20.70	$32.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.90 / $50.25 / $87.42	Professional	TC	$45.90	$50.25	$87.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $15.19 / $20.77 / $21.76	Facility	26	$15.19	$20.77	$21.76
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.46 / $18.39 / $22.74	Professional	26	$12.46	$18.39	$22.74
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.55 / $42.93 / $57.62	Professional	TC	$30.55	$42.93	$57.62
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $12.36 / $12.36 / $12.36	Facility	26	$12.36	$12.36	$12.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $58.63 / $83.90 / $111.15	Professional		$58.63	$83.90	$111.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.32 / $21.08 / $30.78	Professional	26	$14.32	$21.08	$30.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $36.06 / $56.44 / $81.62	Professional	TC	$36.06	$56.44	$81.62
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 $68.31 / $81.52 / $107.36	Professional		$68.31	$81.52	$107.36
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.07 / $22.24 / $30.32	Professional	26	$19.07	$22.24	$30.32
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $49.41 / $59.60 / $78.23	Professional	TC	$49.41	$59.60	$78.23
United Facility/Professional Professional Modifier Low / Median / High Price $34.72 / $49.44 / $116.48	Professional		$34.72	$49.44	$116.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.84 / $12.87 / $33.79	Professional	26	$10.84	$12.87	$33.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.68 / $34.75 / $77.53	Professional	TC	$23.68	$34.75	$77.53