Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.12 / $32.69 / $71.18	Facility	26	$28.12	$32.69	$71.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.09 / $59.47 / $232.00	Professional		$41.09	$59.47	$232.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.74 / $15.46 / $36.15	Professional	26	$11.74	$15.46	$36.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.97 / $42.76 / $112.32	Professional	TC	$26.97	$42.76	$112.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.20 / $16.20 / $16.20	Facility	26	$16.20	$16.20	$16.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.83 / $106.95 / $152.40	Professional		$60.83	$106.95	$152.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.63 / $28.38 / $41.35	Professional	26	$16.63	$28.38	$41.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.00 / $79.30 / $112.40	Professional	TC	$45.00	$79.30	$112.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $106.61 / $126.79 / $146.74	Professional		$106.61	$126.79	$146.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.97 / $32.24 / $36.29	Professional	26	$26.97	$32.24	$36.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $78.81 / $94.11 / $110.47	Professional	TC	$78.81	$94.11	$110.47
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $86.24 / $96.60 / $157.59	Professional		$86.24	$96.60	$157.59
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.42 / $30.50 / $43.71	Professional	26	$22.42	$30.50	$43.71
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $64.05 / $84.02 / $115.92	Professional	TC	$64.05	$84.02	$115.92
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $21.32 / $27.80 / $29.48	Facility	26	$21.32	$27.80	$29.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.05 / $23.10 / $29.69	Professional	26	$18.05	$23.10	$29.69
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $52.16 / $69.06 / $79.06	Professional	TC	$52.16	$69.06	$79.06
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.20 / $16.20 / $16.20	Facility	26	$16.20	$16.20	$16.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $88.46 / $116.37 / $150.62	Professional		$88.46	$116.37	$150.62
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.14 / $29.35 / $41.35	Professional	26	$19.14	$29.35	$41.35
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $48.92 / $81.45 / $116.04	Professional	TC	$48.92	$81.45	$116.04
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 $92.77 / $111.20 / $146.86	Professional		$92.77	$111.20	$146.86
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $25.74 / $30.42 / $40.29	Professional	26	$25.74	$30.42	$40.29
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $67.03 / $81.13 / $106.12	Professional	TC	$67.03	$81.13	$106.12
United Facility/Professional Professional Modifier Low / Median / High Price $39.51 / $59.54 / $155.03	Professional		$39.51	$59.54	$155.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.07 / $18.86 / $43.42	Professional	26	$11.07	$18.86	$43.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.44 / $45.81 / $111.61	Professional	TC	$28.44	$45.81	$111.61