Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.28 / $18.07 / $40.54	Facility	26	$14.28	$18.07	$40.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.51 / $45.17 / $147.00	Professional		$30.51	$45.17	$147.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.96 / $9.91 / $24.96	Professional	26	$6.96	$9.91	$24.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.26 / $30.64 / $80.04	Professional	TC	$22.26	$30.64	$80.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.30 / $9.30 / $9.30	Facility	26	$9.30	$9.30	$9.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.53 / $70.34 / $111.70	Professional		$35.53	$70.34	$111.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.08 / $16.63 / $24.14	Professional	26	$10.08	$16.63	$24.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.31 / $56.22 / $89.19	Professional	TC	$26.31	$56.22	$89.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $78.95 / $94.10 / $109.25	Professional		$78.95	$94.10	$109.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.95 / $19.18 / $21.60	Professional	26	$15.95	$19.18	$21.60
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $62.53 / $74.67 / $87.65	Professional	TC	$62.53	$74.67	$87.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $52.80 / $67.94 / $121.98	Professional		$52.80	$67.94	$121.98
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.35 / $16.07 / $25.41	Professional	26	$13.35	$16.07	$25.41
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.96 / $62.07 / $96.57	Professional	TC	$36.96	$62.07	$96.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $12.11 / $16.07 / $17.00	Facility	26	$12.11	$16.07	$17.00
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.05 / $15.00 / $19.14	Professional	26	$10.05	$15.00	$19.14
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.55 / $42.18 / $57.95	Professional	TC	$30.55	$42.18	$57.95
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.30 / $9.30 / $9.30	Facility	26	$9.30	$9.30	$9.30
Providence Facility/Professional Professional Modifier Low / Median / High Price $58.10 / $84.00 / $114.95	Professional		$58.10	$84.00	$114.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.33 / $17.21 / $24.14	Professional	26	$11.33	$17.21	$24.14
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $35.15 / $62.75 / $90.10	Professional	TC	$35.15	$62.75	$90.10
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $209.36 / $209.36 / $209.36	Facility	26	$209.36	$209.36	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $65.81 / $82.47 / $111.50	Professional		$65.81	$82.47	$111.50
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.96 / $17.92 / $23.69	Professional	26	$14.96	$17.92	$23.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $47.97 / $65.76 / $88.08	Professional	TC	$47.97	$65.76	$88.08
United Facility/Professional Professional Modifier Low / Median / High Price $33.06 / $40.19 / $112.67	Professional		$33.06	$40.19	$112.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.97 / $10.56 / $25.83	Professional	26	$8.97	$10.56	$25.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.25 / $43.68 / $105.44	Professional	TC	$24.25	$43.68	$105.44