Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.75 / $33.94 / $75.69	Facility	26	$29.75	$33.94	$75.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.99 / $61.46 / $111.02	Professional		$32.99	$61.46	$111.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.38 / $17.29 / $53.49	Professional	26	$12.38	$17.29	$53.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.76 / $45.52 / $72.59	Professional	TC	$20.76	$45.52	$72.59
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 $55.69 / $80.16 / $121.94	Professional		$55.69	$80.16	$121.94
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 $33.36 / $53.76 / $77.69	Professional	TC	$33.36	$53.76	$77.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.53 / $96.69 / $111.41	Professional		$81.53	$96.69	$111.41
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.70 / $34.27 / $38.58	Professional	26	$28.70	$34.27	$38.58
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.97 / $62.05 / $72.83	Professional	TC	$51.97	$62.05	$72.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $62.16 / $72.20 / $129.36	Professional		$62.16	$72.20	$129.36
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.02 / $31.22 / $45.75	Professional	26	$24.02	$31.22	$45.75
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.16 / $60.04 / $83.80	Professional	TC	$42.16	$60.04	$83.80
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $22.54 / $29.57 / $30.82	Facility	26	$22.54	$29.57	$30.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.39 / $25.06 / $34.04	Professional	26	$18.39	$25.06	$34.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $27.82 / $43.44 / $87.10	Professional	TC	$27.82	$43.44	$87.10
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 $65.29 / $90.74 / $120.70	Professional		$65.29	$90.74	$120.70
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.93 / $30.49 / $44.27	Professional	26	$19.93	$30.49	$44.27
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $34.04 / $56.68 / $77.69	Professional	TC	$34.04	$56.68	$77.69
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.78 / $851.78 / $851.78	Facility	26	$851.78	$851.78	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $74.20 / $87.18 / $112.82	Professional		$74.20	$87.18	$112.82
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 $45.99 / $54.91 / $71.87	Professional	TC	$45.99	$54.91	$71.87
United Facility/Professional Professional Modifier Low / Median / High Price $38.40 / $69.33 / $131.91	Professional		$38.40	$69.33	$131.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.76 / $21.11 / $45.77	Professional	26	$15.76	$21.11	$45.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.20 / $28.76 / $73.33	Professional	TC	$21.20	$28.76	$73.33