Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.58 / $33.86 / $75.83	Facility	26	$25.58	$33.86	$75.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.96 / $42.79 / $114.39	Professional		$18.96	$42.79	$114.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.48 / $17.77 / $52.51	Professional	26	$7.48	$17.77	$52.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $11.48 / $23.28 / $60.27	Professional	TC	$11.48	$23.28	$60.27
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 $24.95 / $57.73 / $117.17	Professional		$24.95	$57.73	$117.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.24 / $22.74 / $40.81	Professional	26	$10.24	$22.74	$40.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.64 / $35.56 / $77.84	Professional	TC	$13.64	$35.56	$77.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $84.82 / $100.68 / $116.10	Professional		$84.82	$100.68	$116.10
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 $55.26 / $65.98 / $77.47	Professional	TC	$55.26	$65.98	$77.47
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $28.80 / $73.03 / $128.10	Professional		$28.80	$73.03	$128.10
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.52 / $29.09 / $45.75	Professional	26	$14.52	$29.09	$45.75
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.40 / $49.18 / $82.35	Professional	TC	$26.40	$49.18	$82.35
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.11 / $24.73 / $30.15	Facility	26	$13.11	$24.73	$30.15
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $16.16 / $16.16 / $16.16	Professional		$16.16	$16.16	$16.16
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.49 / $15.07 / $31.07	Professional	26	$10.49	$15.07	$31.07
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $12.06 / $18.80 / $52.48	Professional	TC	$12.06	$18.80	$52.48
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 $31.80 / $84.48 / $117.77	Professional		$31.80	$84.48	$117.77
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.17 / $25.12 / $42.24	Professional	26	$12.17	$25.12	$42.24
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $13.97 / $45.45 / $78.83	Professional	TC	$13.97	$45.45	$78.83
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,640.24 / $1,640.24 / $1,640.24	Facility	26	$1,640.24	$1,640.24	$1,640.24
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $34.15 / $86.14 / $116.04	Professional		$34.15	$86.14	$116.04
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.72 / $30.29 / $42.64	Professional	26	$14.72	$30.29	$42.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $19.68 / $55.86 / $73.69	Professional	TC	$19.68	$55.86	$73.69
United Facility/Professional Professional Modifier Low / Median / High Price $16.87 / $43.67 / $125.07	Professional		$16.87	$43.67	$125.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.26 / $16.23 / $46.44	Professional	26	$8.26	$16.23	$46.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.10 / $27.43 / $78.23	Professional	TC	$11.10	$27.43	$78.23