Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $22.39 / $31.62	Facility	26	$17.38	$22.39	$31.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $53.70 / $158.49	Professional		$37.15	$53.70	$158.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.14 / $35.48	Professional	26	$10.00	$15.14	$35.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $34.67 / $79.43	Professional	TC	$25.70	$34.67	$79.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $87.10 / $131.83	Professional		$44.67	$87.10	$131.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $23.44 / $37.15	Professional	26	$13.18	$23.44	$37.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $63.10 / $100.00	Professional	TC	$31.62	$63.10	$100.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $102.33 / $125.89	Professional		$91.20	$102.33	$125.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $26.30 / $31.62	Professional	26	$23.44	$26.30	$31.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $75.86 / $95.50	Professional	TC	$66.07	$75.86	$95.50
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $21.38 / $25.70	Facility	26	$17.38	$21.38	$25.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $85.11 / $138.04	Professional		$52.48	$85.11	$138.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $25.12 / $37.15	Professional	26	$13.18	$25.12	$37.15
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $67.61 / $95.50	Professional	TC	$35.48	$67.61	$95.50
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.42 / $24.55 / $25.70	Facility	26	$20.42	$24.55	$25.70
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $43.65 / $43.65	Professional		$43.65	$43.65	$43.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $21.88 / $27.54	Professional	26	$14.79	$21.88	$27.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $50.12 / $70.79	Professional	TC	$36.31	$50.12	$70.79
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.02 / $14.13 / $20.42	Facility	26	$3.02	$14.13	$20.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $93.33 / $138.04	Professional		$70.79	$93.33	$138.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $25.70 / $36.31	Professional	26	$16.98	$25.70	$36.31
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $63.10 / $100.00	Professional	TC	$41.69	$63.10	$100.00
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $95.50 / $123.03	Professional		$77.62	$95.50	$123.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $26.30 / $33.88	Professional	26	$22.39	$26.30	$33.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $69.18 / $91.20	Professional	TC	$53.70	$69.18	$91.20
United Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $53.70 / $123.03	Professional		$41.69	$53.70	$123.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $15.49 / $35.48	Professional	26	$12.02	$15.49	$35.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $38.90 / $91.20	Professional	TC	$28.18	$38.90	$91.20