Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.04 / $29.30 / $59.20	Facility	26	$20.04	$29.30	$59.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.04 / $48.43 / $133.66	Professional		$34.04	$48.43	$133.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.41 / $12.04 / $30.07	Professional	26	$9.41	$12.04	$30.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.47 / $36.36 / $87.40	Professional	TC	$24.47	$36.36	$87.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.50 / $13.50 / $13.50	Facility	26	$13.50	$13.50	$13.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.06 / $83.64 / $123.68	Professional		$46.06	$83.64	$123.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.01 / $21.34 / $32.50	Professional	26	$12.01	$21.34	$32.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.45 / $62.55 / $92.96	Professional	TC	$36.45	$62.55	$92.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $88.30 / $104.96 / $121.53	Professional		$88.30	$104.96	$121.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.45 / $26.82 / $30.19	Professional	26	$22.45	$26.82	$30.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $65.16 / $77.81 / $91.36	Professional	TC	$65.16	$77.81	$91.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $62.72 / $79.38 / $133.49	Professional		$62.72	$79.38	$133.49
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.68 / $23.89 / $35.58	Professional	26	$18.68	$23.89	$35.58
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.83 / $64.68 / $99.63	Professional	TC	$52.83	$64.68	$99.63
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $15.19 / $20.77 / $23.45	Facility	26	$15.19	$20.77	$23.45
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.02 / $18.55 / $23.64	Professional	26	$13.02	$18.55	$23.64
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $37.04 / $50.56 / $66.33	Professional	TC	$37.04	$50.56	$66.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.50 / $13.50 / $13.50	Facility	26	$13.50	$13.50	$13.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $65.91 / $95.20 / $126.35	Professional		$65.91	$95.20	$126.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.67 / $22.73 / $32.85	Professional	26	$15.67	$22.73	$32.85
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $43.40 / $64.87 / $92.96	Professional	TC	$43.40	$64.87	$92.96
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 $79.23 / $91.79 / $121.81	Professional		$79.23	$91.79	$121.81
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.07 / $24.33 / $33.15	Professional	26	$19.07	$24.33	$33.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $57.31 / $67.81 / $89.39	Professional	TC	$57.31	$67.81	$89.39
United Facility/Professional Professional Modifier Low / Median / High Price $39.17 / $50.04 / $125.07	Professional		$39.17	$50.04	$125.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.11 / $13.44 / $36.11	Professional	26	$11.11	$13.44	$36.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.03 / $37.82 / $101.53	Professional	TC	$28.03	$37.82	$101.53