Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.87 / $24.21 / $54.20	Facility	26	$17.87	$24.21	$54.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.19 / $52.18 / $200.58	Professional		$31.19	$52.18	$200.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.96 / $12.21 / $29.88	Professional	26	$8.96	$12.21	$29.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.47 / $41.64 / $82.75	Professional	TC	$22.47	$41.64	$82.75
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.17 / $79.22 / $119.90	Professional		$48.17	$79.22	$119.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.42 / $21.04 / $31.10	Professional	26	$12.42	$21.04	$31.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.92 / $59.38 / $88.50	Professional	TC	$35.92	$59.38	$88.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $80.34 / $95.53 / $110.65	Professional		$80.34	$95.53	$110.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.48 / $24.54 / $27.62	Professional	26	$20.48	$24.54	$27.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $59.22 / $70.70 / $83.03	Professional	TC	$59.22	$70.70	$83.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $62.50 / $76.23 / $122.44	Professional		$62.50	$76.23	$122.44
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 $48.03 / $65.79 / $91.50	Professional	TC	$48.03	$65.79	$91.50
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $15.68 / $21.12 / $21.76	Facility	26	$15.68	$21.12	$21.76
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.67 / $19.38 / $23.38	Professional	26	$13.67	$19.38	$23.38
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $32.96 / $54.59 / $68.44	Professional	TC	$32.96	$54.59	$68.44
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Providence Facility/Professional Professional Modifier Low / Median / High Price $66.67 / $90.28 / $118.34	Professional		$66.67	$90.28	$118.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.50 / $21.79 / $31.47	Professional	26	$14.50	$21.79	$31.47
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $40.77 / $62.52 / $88.50	Professional	TC	$40.77	$62.52	$88.50
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 $73.02 / $85.61 / $111.50	Professional		$73.02	$85.61	$111.50
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.14 / $22.74 / $30.32	Professional	26	$19.14	$22.74	$30.32
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $53.29 / $62.97 / $82.09	Professional	TC	$53.29	$62.97	$82.09
United Facility/Professional Professional Modifier Low / Median / High Price $40.06 / $47.82 / $129.79	Professional		$40.06	$47.82	$129.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.98 / $13.30 / $33.72	Professional	26	$10.98	$13.30	$33.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.51 / $37.06 / $81.52	Professional	TC	$28.51	$37.06	$81.52