Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.76 / $27.00 / $62.72	Facility	26	$17.76	$27.00	$62.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.20 / $70.94 / $217.65	Professional		$50.20	$70.94	$217.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.67 / $19.70 / $60.60	Professional	26	$12.67	$19.70	$60.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.57 / $47.02 / $115.17	Professional	TC	$36.57	$47.02	$115.17
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 $53.74 / $100.22 / $144.34	Professional		$53.74	$100.22	$144.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.05 / $27.48 / $41.48	Professional	26	$17.05	$27.48	$41.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.79 / $72.18 / $110.87	Professional	TC	$38.79	$72.18	$110.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.84 / $122.33 / $141.83	Professional		$102.84	$122.33	$141.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.38 / $29.21 / $32.89	Professional	26	$24.38	$29.21	$32.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $77.72 / $92.80 / $108.97	Professional	TC	$77.72	$92.80	$108.97
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $76.16 / $89.70 / $153.56	Professional		$76.16	$89.70	$153.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.28 / $26.79 / $37.61	Professional	26	$20.28	$26.79	$37.61
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $62.98 / $76.97 / $118.95	Professional	TC	$62.98	$76.97	$118.95
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.35 / $24.79 / $30.15	Facility	26	$20.35	$24.79	$30.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.48 / $25.55 / $31.17	Professional	26	$18.48	$25.55	$31.17
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $41.00 / $59.52 / $79.73	Professional	TC	$41.00	$59.52	$79.73
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 $80.83 / $109.78 / $145.41	Professional		$80.83	$109.78	$145.41
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $27.74 / $41.48	Professional	26	$17.07	$27.74	$41.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $51.13 / $75.84 / $111.78	Professional	TC	$51.13	$75.84	$111.78
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 $90.28 / $108.34 / $140.11	Professional		$90.28	$108.34	$140.11
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $22.14 / $28.73 / $35.34	Professional	26	$22.14	$28.73	$35.34
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $62.85 / $81.25 / $106.45	Professional	TC	$62.85	$81.25	$106.45
United Facility/Professional Professional Modifier Low / Median / High Price $49.08 / $63.80 / $140.35	Professional		$49.08	$63.80	$140.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.35 / $17.36 / $38.22	Professional	26	$13.35	$17.36	$38.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.38 / $39.65 / $103.73	Professional	TC	$33.38	$39.65	$103.73