Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $22.91 / $28.18	Facility	26	$13.80	$22.91	$28.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $40.74 / $112.20	Professional		$28.18	$40.74	$112.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.30 / $25.70	Professional	26	$7.94	$12.30	$25.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $28.84 / $57.54	Professional	TC	$19.05	$28.84	$57.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $67.61 / $102.33	Professional		$36.31	$67.61	$102.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $19.50 / $30.90	Professional	26	$11.75	$19.50	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $46.77 / $72.44	Professional	TC	$26.30	$46.77	$72.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $75.86 / $93.33	Professional		$67.61	$75.86	$93.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $21.38 / $25.70	Professional	26	$19.05	$21.38	$25.70
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $53.70 / $67.61	Professional	TC	$47.86	$53.70	$67.61
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $20.42 / $28.18	Facility	26	$13.80	$20.42	$28.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $64.57 / $102.33	Professional		$39.81	$64.57	$102.33
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $20.42 / $29.51	Professional	26	$10.72	$20.42	$29.51
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $50.12 / $74.13	Professional	TC	$28.84	$50.12	$74.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $19.95 / $20.89	Facility	26	$16.60	$19.95	$20.89
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $19.50 / $22.91	Professional	26	$12.88	$19.50	$22.91
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $38.02 / $50.12	Professional	TC	$26.30	$38.02	$50.12
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.45 / $11.48 / $16.22	Facility	26	$2.45	$11.48	$16.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $70.79 / $100.00	Professional		$54.95	$70.79	$100.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $22.39 / $30.20	Professional	26	$14.45	$22.39	$30.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $47.86 / $72.44	Professional	TC	$32.36	$47.86	$72.44
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $208.93 / $208.93 / $208.93	Facility	26	$208.93	$208.93	$208.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $70.79 / $91.20	Professional		$60.26	$70.79	$91.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $21.88 / $27.54	Professional	26	$18.20	$21.88	$27.54
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $48.98 / $64.57	Professional	TC	$41.69	$48.98	$64.57
United Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $41.69 / $91.20	Professional		$33.11	$41.69	$91.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $13.18 / $28.84	Professional	26	$10.23	$13.18	$28.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $27.54 / $64.57	Professional	TC	$21.38	$27.54	$64.57