Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $24.55 / $48.98	Facility	26	$14.79	$24.55	$48.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $54.95 / $117.49	Professional		$32.36	$54.95	$117.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $14.79 / $33.88	Professional	26	$8.91	$14.79	$33.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $33.11 / $72.44	Professional	TC	$21.88	$33.11	$72.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $74.13 / $112.20	Professional		$38.02	$74.13	$112.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $19.95 / $30.90	Professional	26	$11.22	$19.95	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $53.70 / $83.18	Professional	TC	$28.18	$53.70	$83.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $85.11 / $107.15	Professional		$74.13	$85.11	$107.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $22.91 / $27.54	Professional	26	$19.50	$22.91	$27.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $61.66 / $79.43	Professional	TC	$54.95	$61.66	$79.43
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $21.38 / $50.12	Facility	26	$14.79	$21.38	$50.12
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $70.79 / $117.49	Professional		$43.65	$70.79	$117.49
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $20.89 / $32.36	Professional	26	$10.72	$20.89	$32.36
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $54.95 / $79.43	Professional	TC	$29.51	$54.95	$79.43
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.78 / $20.89 / $21.88	Facility	26	$17.78	$20.89	$21.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $17.78 / $22.39	Professional	26	$12.59	$17.78	$22.39
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $41.69 / $54.95	Professional	TC	$30.20	$41.69	$54.95
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $79.43 / $114.82	Professional		$60.26	$79.43	$114.82
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $21.88 / $30.90	Professional	26	$14.79	$21.88	$30.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $54.95 / $83.18	Professional	TC	$36.31	$54.95	$83.18
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 $66.07 / $79.43 / $104.71	Professional		$66.07	$79.43	$104.71
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $22.39 / $28.84	Professional	26	$19.05	$22.39	$28.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $57.54 / $75.86	Professional	TC	$44.67	$57.54	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $47.86 / $104.71	Professional		$34.67	$47.86	$104.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $12.88 / $28.84	Professional	26	$10.23	$12.88	$28.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $32.36 / $75.86	Professional	TC	$23.44	$32.36	$75.86