Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $30.20 / $33.88	Facility	26	$21.88	$30.20	$33.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $50.12 / $154.88	Professional		$37.15	$50.12	$154.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $15.14 / $36.31	Professional	26	$10.96	$15.14	$36.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $34.67 / $74.13	Professional	TC	$22.91	$34.67	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $89.13 / $138.04	Professional		$45.71	$89.13	$138.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $25.70 / $39.81	Professional	26	$14.45	$25.70	$39.81
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 / $104.71 / $128.82	Professional		$91.20	$104.71	$128.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $28.18 / $34.67	Professional	26	$25.12	$28.18	$34.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $75.86 / $95.50	Professional	TC	$64.57	$75.86	$95.50
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $33.88 / $33.88	Facility	26	$22.91	$33.88	$33.88
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $85.11 / $141.25	Professional		$56.23	$85.11	$141.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $26.92 / $39.81	Professional	26	$15.14	$26.92	$39.81
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $67.61 / $102.33	Professional	TC	$38.02	$67.61	$102.33
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $26.30 / $26.92	Facility	26	$21.88	$26.30	$26.92
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $24.55 / $30.20	Professional	26	$16.98	$24.55	$30.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $52.48 / $74.13	Professional	TC	$37.15	$52.48	$74.13
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.24 / $15.14 / $21.88	Facility	26	$3.24	$15.14	$21.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $95.50 / $141.25	Professional		$72.44	$95.50	$141.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $27.54 / $38.90	Professional	26	$18.62	$27.54	$38.90
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 $79.43 / $97.72 / $125.89	Professional		$79.43	$97.72	$125.89
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $28.18 / $36.31	Professional	26	$23.99	$28.18	$36.31
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $67.61 / $91.20	Professional	TC	$53.70	$67.61	$91.20
United Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $54.95 / $125.89	Professional		$42.66	$54.95	$125.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $16.98 / $37.15	Professional	26	$13.18	$16.98	$37.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $38.90 / $91.20	Professional	TC	$28.18	$38.90	$91.20