Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.85 / $34.64 / $70.03	Facility	26	$25.85	$34.64	$70.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.58 / $55.10 / $254.00	Professional		$40.58	$55.10	$254.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.58 / $20.48 / $70.45	Professional	26	$13.58	$20.48	$70.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.08 / $37.43 / $87.59	Professional	TC	$28.08	$37.43	$87.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.36 / $17.36 / $17.36	Facility	26	$17.36	$17.36	$17.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.20 / $93.98 / $137.87	Professional		$48.20	$93.98	$137.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.42 / $29.73 / $44.25	Professional	26	$17.42	$29.73	$44.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.50 / $61.89 / $97.68	Professional	TC	$31.50	$61.89	$97.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $98.70 / $117.25 / $135.47	Professional		$98.70	$117.25	$135.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.32 / $35.07 / $39.49	Professional	26	$29.32	$35.07	$39.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $68.48 / $81.76 / $95.98	Professional	TC	$68.48	$81.76	$95.98
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $73.36 / $85.14 / $149.55	Professional		$73.36	$85.14	$149.55
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $30.42 / $46.77	Professional	26	$24.55	$30.42	$46.77
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $55.51 / $73.78 / $105.72	Professional	TC	$55.51	$73.78	$105.72
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $22.29 / $29.36 / $30.82	Facility	26	$22.29	$29.36	$30.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $19.80 / $26.33 / $32.65	Professional	26	$19.80	$26.33	$32.65
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $37.92 / $54.15 / $68.00	Professional	TC	$37.92	$54.15	$68.00
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $17.36 / $17.36 / $17.36	Facility	26	$17.36	$17.36	$17.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $74.03 / $106.91 / $141.55	Professional		$74.03	$106.91	$141.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $20.39 / $30.83 / $44.27	Professional	26	$20.39	$30.83	$44.27
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.41 / $68.30 / $98.59	Professional	TC	$42.41	$68.30	$98.59
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 $88.56 / $102.89 / $136.47	Professional		$88.56	$102.89	$136.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $27.53 / $32.54 / $43.16	Professional	26	$27.53	$32.54	$43.16
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $60.14 / $71.93 / $94.86	Professional	TC	$60.14	$71.93	$94.86
United Facility/Professional Professional Modifier Low / Median / High Price $44.20 / $59.92 / $140.56	Professional		$44.20	$59.92	$140.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.09 / $16.51 / $46.08	Professional	26	$15.09	$16.51	$46.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.29 / $40.79 / $94.05	Professional	TC	$28.29	$40.79	$94.05