Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.10 / $33.09 / $71.25	Facility	26	$24.10	$33.09	$71.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.79 / $82.79 / $302.57	Professional		$55.79	$82.79	$302.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.08 / $20.09 / $43.40	Professional	26	$12.08	$20.09	$43.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.38 / $59.88 / $117.71	Professional	TC	$38.38	$59.88	$117.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.57 / $16.57 / $16.57	Facility	26	$16.57	$16.57	$16.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.23 / $119.65 / $171.81	Professional		$71.23	$119.65	$171.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $30.57 / $45.15	Professional	26	$19.50	$30.57	$45.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.32 / $92.60 / $132.51	Professional	TC	$51.32	$92.60	$132.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $121.15 / $144.18 / $167.12	Professional		$121.15	$144.18	$167.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.03 / $33.57 / $37.79	Professional	26	$28.03	$33.57	$37.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $92.26 / $110.16 / $129.35	Professional	TC	$92.26	$110.16	$129.35
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $93.52 / $109.00 / $185.69	Professional		$93.52	$109.00	$185.69
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.48 / $32.13 / $44.73	Professional	26	$23.48	$32.13	$44.73
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $74.73 / $95.34 / $144.36	Professional	TC	$74.73	$95.34	$144.36
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $22.77 / $28.81 / $32.83	Facility	26	$22.77	$28.81	$32.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.89 / $27.13 / $34.31	Professional	26	$18.89	$27.13	$34.31
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $54.27 / $79.65 / $95.25	Professional	TC	$54.27	$79.65	$95.25
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.57 / $16.57 / $16.57	Facility	26	$16.57	$16.57	$16.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $100.78 / $134.85 / $177.85	Professional		$100.78	$134.85	$177.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.62 / $30.69 / $45.28	Professional	26	$19.62	$30.69	$45.28
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $64.33 / $96.15 / $132.51	Professional	TC	$64.33	$96.15	$132.51
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 $111.32 / $127.88 / $169.60	Professional		$111.32	$127.88	$169.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $26.33 / $32.58 / $41.69	Professional	26	$26.33	$32.58	$41.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $84.53 / $96.59 / $129.52	Professional	TC	$84.53	$96.59	$129.52
United Facility/Professional Professional Modifier Low / Median / High Price $60.27 / $100.20 / $205.80	Professional		$60.27	$100.20	$205.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.52 / $19.30 / $46.37	Professional	26	$15.52	$19.30	$46.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.75 / $64.48 / $128.16	Professional	TC	$44.75	$64.48	$128.16