Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.38 / $29.62 / $66.18	Facility	26	$22.38	$29.62	$66.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.93 / $66.38 / $138.16	Professional		$46.93	$66.38	$138.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.81 / $14.25 / $33.61	Professional	26	$10.81	$14.25	$33.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.14 / $44.14 / $117.71	Professional	TC	$34.14	$44.14	$117.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.00 / $15.00 / $15.00	Facility	26	$15.00	$15.00	$15.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.40 / $104.35 / $168.42	Professional		$56.40	$104.35	$168.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.84 / $26.51 / $38.47	Professional	26	$15.84	$26.51	$38.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.68 / $81.79 / $133.50	Professional	TC	$40.68	$81.79	$133.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $119.81 / $142.68 / $165.51	Professional		$119.81	$142.68	$165.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.44 / $30.48 / $34.32	Professional	26	$25.44	$30.48	$34.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $93.58 / $111.74 / $131.19	Professional	TC	$93.58	$111.74	$131.19
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $87.60 / $105.97 / $180.96	Professional		$87.60	$105.97	$180.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.35 / $28.21 / $39.65	Professional	26	$21.35	$28.21	$39.65
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.78 / $100.13 / $141.30	Professional	TC	$75.78	$100.13	$141.30
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $19.86 / $25.40 / $27.47	Facility	26	$19.86	$25.40	$27.47
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $16.48 / $21.45 / $27.88	Professional	26	$16.48	$21.45	$27.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $48.30 / $76.45 / $94.47	Professional	TC	$48.30	$76.45	$94.47
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $15.00 / $15.00 / $15.00	Facility	26	$15.00	$15.00	$15.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $85.55 / $126.72 / $170.72	Professional		$85.55	$126.72	$170.72
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.67 / $27.76 / $38.47	Professional	26	$17.67	$27.76	$38.47
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $55.08 / $90.27 / $133.50	Professional	TC	$55.08	$90.27	$133.50
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 $89.18 / $123.30 / $161.94	Professional		$89.18	$123.30	$161.94
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.34 / $28.30 / $36.95	Professional	26	$23.34	$28.30	$36.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $64.58 / $96.59 / $126.46	Professional	TC	$64.58	$96.59	$126.46
United Facility/Professional Professional Modifier Low / Median / High Price $52.10 / $71.90 / $162.28	Professional		$52.10	$71.90	$162.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $17.57 / $40.22	Professional	26	$14.07	$17.57	$40.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.36 / $56.32 / $146.49	Professional	TC	$37.36	$56.32	$146.49