Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.21 / $28.09 / $58.03	Facility	26	$21.21	$28.09	$58.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.09 / $48.49 / $166.40	Professional		$35.09	$48.49	$166.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.82 / $17.25 / $70.84	Professional	26	$11.82	$17.25	$70.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.26 / $32.83 / $83.66	Professional	TC	$23.26	$32.83	$83.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.26 / $14.26 / $14.26	Facility	26	$14.26	$14.26	$14.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.94 / $77.20 / $118.89	Professional		$41.94	$77.20	$118.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.73 / $24.52 / $36.50	Professional	26	$14.73	$24.52	$36.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.71 / $53.84 / $86.37	Professional	TC	$27.71	$53.84	$86.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.01 / $100.99 / $116.83	Professional		$85.01	$100.99	$116.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.73 / $28.39 / $31.96	Professional	26	$23.73	$28.39	$31.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $60.54 / $72.29 / $84.87	Professional	TC	$60.54	$72.29	$84.87
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $63.84 / $75.11 / $130.13	Professional		$63.84	$75.11	$130.13
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.75 / $25.69 / $37.61	Professional	26	$19.75	$25.69	$37.61
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.10 / $64.88 / $92.52	Professional	TC	$49.10	$64.88	$92.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $18.41 / $24.46 / $25.46	Facility	26	$18.41	$24.46	$25.46
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $16.27 / $21.76 / $26.79	Professional	26	$16.27	$21.76	$26.79
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $34.74 / $50.05 / $60.97	Professional	TC	$34.74	$50.05	$60.97
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.26 / $14.26 / $14.26	Facility	26	$14.26	$14.26	$14.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $91.52 / $122.74	Professional		$64.31	$91.52	$122.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.76 / $25.73 / $37.44	Professional	26	$16.76	$25.73	$37.44
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.20 / $58.69 / $86.37	Professional	TC	$37.20	$58.69	$86.37
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $209.36 / $209.36 / $209.36	Facility	26	$209.36	$209.36	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $67.04 / $88.96 / $116.45	Professional		$67.04	$88.96	$116.45
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $22.14 / $27.39 / $35.06	Professional	26	$22.14	$27.39	$35.06
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $43.67 / $62.34 / $82.79	Professional	TC	$43.67	$62.34	$82.79
United Facility/Professional Professional Modifier Low / Median / High Price $39.17 / $43.38 / $132.62	Professional		$39.17	$43.38	$132.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.61 / $16.62 / $38.90	Professional	26	$13.61	$16.62	$38.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.52 / $33.44 / $81.65	Professional	TC	$25.52	$33.44	$81.65