Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.39 / $34.67 / $38.02	Facility	26	$22.39	$34.67	$38.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $48.98 / $128.82	Professional		$33.88	$48.98	$128.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $15.14 / $34.67	Professional	26	$10.96	$15.14	$34.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $32.36 / $69.18	Professional	TC	$22.91	$32.36	$69.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $81.28 / $125.89	Professional		$40.74	$81.28	$125.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $25.70 / $40.74	Professional	26	$14.13	$25.70	$40.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $56.23 / $87.10	Professional	TC	$29.51	$56.23	$87.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $95.50 / $117.49	Professional		$83.18	$95.50	$117.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $29.51 / $35.48	Professional	26	$25.70	$29.51	$35.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $64.57 / $83.18	Professional	TC	$57.54	$64.57	$83.18
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $23.44 / $34.67 / $48.98	Facility	26	$23.44	$34.67	$48.98
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $77.62 / $128.82	Professional		$51.29	$77.62	$128.82
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $27.54 / $40.74	Professional	26	$14.13	$27.54	$40.74
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $58.88 / $83.18	Professional	TC	$33.88	$58.88	$83.18
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $22.39 / $26.30 / $28.18	Facility	26	$22.39	$26.30	$28.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $23.44 / $28.18	Professional	26	$16.22	$23.44	$28.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $44.67 / $58.88	Professional	TC	$31.62	$44.67	$58.88
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.39 / $15.85 / $22.39	Facility	26	$3.39	$15.85	$22.39
Providence Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $87.10 / $125.89	Professional		$66.07	$87.10	$125.89
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $26.92 / $40.74	Professional	26	$19.05	$26.92	$40.74
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $57.54 / $87.10	Professional	TC	$37.15	$57.54	$87.10
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 $72.44 / $91.20 / $117.49	Professional		$72.44	$91.20	$117.49
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $29.51 / $37.15	Professional	26	$23.99	$29.51	$37.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $60.26 / $79.43	Professional	TC	$44.67	$60.26	$79.43
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $52.48 / $114.82	Professional		$38.02	$52.48	$114.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $16.22 / $37.15	Professional	26	$13.18	$16.22	$37.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $33.88 / $79.43	Professional	TC	$23.99	$33.88	$79.43