Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.90 / $32.19 / $75.83	Facility	26	$20.90	$32.19	$75.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.49 / $68.58 / $240.00	Professional		$51.49	$68.58	$240.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $17.26 / $57.20	Professional	26	$14.36	$17.26	$57.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.11 / $45.76 / $116.07	Professional	TC	$37.11	$45.76	$116.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.25 / $113.22 / $171.88	Professional		$61.25	$113.22	$171.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.79 / $29.76 / $44.31	Professional	26	$17.79	$29.76	$44.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.21 / $83.57 / $132.55	Professional	TC	$44.21	$83.57	$132.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $122.48 / $145.72 / $168.91	Professional		$122.48	$145.72	$168.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.68 / $34.31 / $38.63	Professional	26	$28.68	$34.31	$38.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $92.92 / $110.95 / $130.25	Professional	TC	$92.92	$110.95	$130.25
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $92.96 / $108.29 / $189.09	Professional		$92.96	$108.29	$189.09
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.02 / $31.74 / $45.75	Professional	26	$24.02	$31.74	$45.75
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.26 / $99.43 / $143.34	Professional	TC	$75.26	$99.43	$143.34
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $22.29 / $29.56 / $30.82	Facility	26	$22.29	$29.56	$30.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.48 / $24.73 / $31.74	Professional	26	$18.48	$24.73	$31.74
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $51.98 / $77.54 / $94.47	Professional	TC	$51.98	$77.54	$94.47
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Providence Facility/Professional Professional Modifier Low / Median / High Price $93.81 / $132.46 / $177.51	Professional		$93.81	$132.46	$177.51
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.93 / $31.26 / $44.32	Professional	26	$19.93	$31.26	$44.32
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $59.82 / $92.33 / $132.55	Professional	TC	$59.82	$92.33	$132.55
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 $97.79 / $129.27 / $169.22	Professional		$97.79	$129.27	$169.22
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $26.93 / $32.54 / $42.64	Professional	26	$26.93	$32.54	$42.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $69.50 / $96.83 / $128.28	Professional	TC	$69.50	$96.83	$128.28
United Facility/Professional Professional Modifier Low / Median / High Price $57.13 / $63.03 / $171.32	Professional		$57.13	$63.03	$171.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.23 / $20.30 / $46.51	Professional	26	$16.23	$20.30	$46.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.60 / $50.62 / $124.88	Professional	TC	$40.60	$50.62	$124.88