Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $28.84 / $34.67	Facility	26	$17.38	$28.84	$34.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $53.70 / $138.04	Professional		$35.48	$53.70	$138.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $17.78 / $39.81	Professional	26	$11.75	$17.78	$39.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $37.15 / $64.57	Professional	TC	$22.91	$37.15	$64.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $79.43 / $123.03	Professional		$40.74	$79.43	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $23.44 / $37.15	Professional	26	$14.13	$23.44	$37.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $54.95 / $89.13	Professional	TC	$27.54	$54.95	$89.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $95.50 / $117.49	Professional		$85.11	$95.50	$117.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $26.92 / $31.62	Professional	26	$23.99	$26.92	$31.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $69.18 / $85.11	Professional	TC	$61.66	$69.18	$85.11
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $26.30 / $34.67	Facility	26	$17.38	$26.30	$34.67
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $79.43 / $125.89	Professional		$46.77	$79.43	$125.89
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $22.91 / $36.31	Professional	26	$14.79	$22.91	$36.31
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $58.88 / $89.13	Professional	TC	$30.20	$58.88	$89.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.42 / $24.55 / $25.70	Facility	26	$20.42	$24.55	$25.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $21.88 / $26.92	Professional	26	$15.14	$21.88	$26.92
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $50.12 / $60.26	Professional	TC	$33.88	$50.12	$60.26
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.02 / $14.13 / $20.42	Facility	26	$3.02	$14.13	$20.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $89.13 / $123.03	Professional		$66.07	$89.13	$123.03
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $26.30 / $37.15	Professional	26	$16.98	$26.30	$37.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $60.26 / $91.20	Professional	TC	$35.48	$60.26	$91.20
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 $67.61 / $87.10 / $112.20	Professional		$67.61	$87.10	$112.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $26.30 / $33.88	Professional	26	$22.39	$26.30	$33.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $60.26 / $79.43	Professional	TC	$43.65	$60.26	$79.43
United Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $48.98 / $112.20	Professional		$38.90	$48.98	$112.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $16.60 / $35.48	Professional	26	$13.49	$16.60	$35.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $33.11 / $79.43	Professional	TC	$25.70	$33.11	$79.43