Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $24.55 / $27.54	Facility	26	$17.38	$24.55	$27.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $53.70 / $194.98	Professional		$33.11	$53.70	$194.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $13.18 / $35.48	Professional	26	$8.91	$13.18	$35.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $39.81 / $70.79	Professional	TC	$22.91	$39.81	$70.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $79.43 / $120.23	Professional		$47.86	$79.43	$120.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $20.89 / $33.11	Professional	26	$11.75	$20.89	$33.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $60.26 / $89.13	Professional	TC	$34.67	$60.26	$89.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $91.20 / $112.20	Professional		$81.28	$91.20	$112.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $22.91 / $27.54	Professional	26	$20.42	$22.91	$27.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $67.61 / $83.18	Professional	TC	$60.26	$67.61	$83.18
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $17.78 / $19.05 / $29.51	Facility	26	$17.78	$19.05	$29.51
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $81.28 / $120.23	Professional		$53.70	$81.28	$120.23
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $21.88 / $31.62	Professional	26	$11.22	$21.88	$31.62
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $63.10 / $89.13	Professional	TC	$39.81	$63.10	$89.13
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 $13.49 / $19.50 / $23.99	Professional	26	$13.49	$19.50	$23.99
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $52.48 / $67.61	Professional	TC	$34.67	$52.48	$67.61
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 $67.61 / $87.10 / $120.23	Professional		$67.61	$87.10	$120.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $22.91 / $31.62	Professional	26	$15.14	$22.91	$31.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $64.57 / $89.13	Professional	TC	$44.67	$64.57	$89.13
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 $70.79 / $85.11 / $107.15	Professional		$70.79	$85.11	$107.15
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $22.91 / $29.51	Professional	26	$19.50	$22.91	$29.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $63.10 / $79.43	Professional	TC	$52.48	$63.10	$79.43
United Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $48.98 / $107.15	Professional		$39.81	$48.98	$107.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $13.18 / $29.51	Professional	26	$10.23	$13.18	$29.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $38.02 / $79.43	Professional	TC	$28.18	$38.02	$79.43