Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.78 / $29.51 / $57.54	Facility	26	$17.78	$29.51	$57.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $52.48 / $162.18	Professional		$26.92	$52.48	$162.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $17.38 / $41.69	Professional	26	$10.96	$17.38	$41.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $40.74 / $74.13	Professional	TC	$22.91	$40.74	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $79.43 / $120.23	Professional		$38.90	$79.43	$120.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $23.99 / $38.02	Professional	26	$13.80	$23.99	$38.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $54.95 / $85.11	Professional	TC	$26.92	$54.95	$85.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $91.20 / $114.82	Professional		$81.28	$91.20	$114.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $26.92 / $33.11	Professional	26	$23.99	$26.92	$33.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $63.10 / $81.28	Professional	TC	$56.23	$63.10	$81.28
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $17.78 / $25.70 / $57.54	Facility	26	$17.78	$25.70	$57.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $74.13 / $125.89	Professional		$42.66	$74.13	$125.89
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $25.12 / $40.74	Professional	26	$12.88	$25.12	$40.74
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $56.23 / $81.28	Professional	TC	$29.51	$56.23	$81.28
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $25.12 / $26.30	Facility	26	$20.89	$25.12	$26.30
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $22.91 / $28.18	Professional	26	$15.14	$22.91	$28.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $43.65 / $54.95	Professional	TC	$30.90	$43.65	$54.95
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.09 / $14.45 / $20.89	Facility	26	$3.09	$14.45	$20.89
Providence Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $83.18 / $123.03	Professional		$63.10	$83.18	$123.03
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $26.30 / $37.15	Professional	26	$17.38	$26.30	$37.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $54.95 / $85.11	Professional	TC	$35.48	$54.95	$85.11
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 $69.18 / $87.10 / $112.20	Professional		$69.18	$87.10	$112.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $26.92 / $34.67	Professional	26	$22.91	$26.92	$34.67
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $58.88 / $77.62	Professional	TC	$43.65	$58.88	$77.62
United Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $47.86 / $109.65	Professional		$37.15	$47.86	$109.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $16.22 / $35.48	Professional	26	$12.88	$16.22	$35.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $32.36 / $77.62	Professional	TC	$22.91	$32.36	$77.62