Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.63 / $27.31 / $61.03	Facility	26	$20.63	$27.31	$61.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.29 / $46.60 / $106.00	Professional		$32.29	$46.60	$106.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.75 / $13.65 / $29.94	Professional	26	$9.75	$13.65	$29.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.28 / $33.78 / $72.12	Professional	TC	$24.28	$33.78	$72.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.86 / $13.86 / $13.86	Facility	26	$13.86	$13.86	$13.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.28 / $79.34 / $117.04	Professional		$41.28	$79.34	$117.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $21.90 / $33.43	Professional	26	$12.02	$21.90	$33.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.92 / $58.31 / $85.39	Professional	TC	$29.92	$58.31	$85.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.02 / $98.64 / $114.13	Professional		$83.02	$98.64	$114.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.07 / $27.63 / $31.10	Professional	26	$23.07	$27.63	$31.10
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 $62.72 / $71.33 / $126.47	Professional		$62.72	$71.33	$126.47
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.14 / $23.51 / $36.60	Professional	26	$19.14	$23.51	$36.60
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.03 / $62.00 / $92.52	Professional	TC	$48.03	$62.00	$92.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $15.19 / $22.11 / $24.12	Facility	26	$15.19	$22.11	$24.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.02 / $18.80 / $24.12	Professional	26	$13.02	$18.80	$24.12
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $31.92 / $48.72 / $60.30	Professional	TC	$31.92	$48.72	$60.30
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.86 / $13.86 / $13.86	Facility	26	$13.86	$13.86	$13.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $63.13 / $90.41 / $120.59	Professional		$63.13	$90.41	$120.59
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.75 / $22.99 / $33.79	Professional	26	$15.75	$22.99	$33.79
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $39.83 / $59.44 / $85.39	Professional	TC	$39.83	$59.44	$85.39
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 $76.01 / $87.96 / $115.54	Professional		$76.01	$87.96	$115.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $20.13 / $24.66 / $34.11	Professional	26	$20.13	$24.66	$34.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $54.40 / $62.95 / $82.79	Professional	TC	$54.40	$62.95	$82.79
United Facility/Professional Professional Modifier Low / Median / High Price $38.45 / $48.47 / $131.58	Professional		$38.45	$48.47	$131.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.50 / $14.38 / $37.15	Professional	26	$11.50	$14.38	$37.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.21 / $44.90 / $80.62	Professional	TC	$27.21	$44.90	$80.62